Well Balanced Body
Thank you for choosing Dr. Malori Tinsley as your Chiropractic provider. We are committed to providing you with quality and affordable health care. Due to some of the questions our patients have regarding patient and insurance responsibility for services rendered, we have been advised to develop this payment policy. Please read it, ask any questions you may have, and sign in the space provided below. A copy will be provided to you upon request.
INSURANCE. I am not a provider in your insurance network because if I was, the insurance company would get to decide how much time I spend with you at each visit and what kind of care I give you as your chiropractor. Instead, I choose the freedom to work directly for you and your needs, determining appropriate care that is completely unique to you and your body. This takes more than the typical 5-10 minutes most chiropractors spend with their patients. I love taking the time to give you the best quality care I can give, and these longer appointments often result in the need for much fewer number of appointments overall. That being said, I understand that many insurance plans cover chiropractic care. I am happy to provide you ‘super bill’ receipts that you can submit to your insurance company to receive a reimbursement.
For Personal Injury or Auto Accident Patients If you are involved in an auto accident or “slip and fall”, all services rendered by our office will be charged directly to you on the day of your appointment, and you are personally responsible for payment. If you have medical payments as part of your auto insurance policy, we will bill to them first. If you retain an attorney, he/she must sign a lien with our office. In the event you are no longer represented by your current attorney and do not retain another, or your auto insurance stops payment, your account is due and payable in full the first day you are not represented. You must supply a credit card number on file for us to collect said funds, and we will auto debit no later then 10 days after not being represented by an attorney or your med-pay expiration date
MISSED APPOINTMENT. We require a 24 hr notice of cancellation. This allows us to get patients booked that are on the wait list for emergencies and need to get in ASAP to receive treatment. With a 24 hour notice of cancellation you allow another patient to get the help that they need. We understand life happens, that is why we have set up text and email reminders. If you know you can’t make it in for your appointment, please give us a cancellation notice of 24 hrs. If you cancel less than 24 hours, there will be a full visit charge to your account for the visit amount.
Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area.
By signing below, you are agreeing that you have have read and understand the payment policy and agree to abide by its guidelines.
INFORMED CONSENT FOR CHIROPRACTIC CARE
To the patient (or their parent, legal guardian, court appointed conservator, or agent): Please read this entire form prior to signing it. It is important that you understand the information contained in this form. Please ask any questions prior to signing this form if you are unclear about anything in this form.
The primary treatment render by the Doctor of Chiropractic to you will be chiropractic adjustments, which are purposely intentioned movements of bones with the desired effect being to remove interference to nerves, which then allows your body to use its innate ability to heal itself. Chiropractic adjustments also have the desirable effect enabling muscles, tendons, and ligaments to properly function and heal, and also allows blood flow to properly occur. Chiropractic adjustments can be made by either the use of hands or mechanical instruments to any bone or joint in the body including both spinal and extremity bones. You may or may not hear an audible sound, which is just air being released from the joint space as bones are moved into their proper positions.
There are a number of other procedures used by Doctors of Chiropractic that may be used on you. A physical examination will be performed to obtain a baseline level of functioning as well to partially determine an appropriate course of treatment and associated recommendations. The physical examination may include posture checks, range of motion testing, muscle strength testing, various neurological and orthopedic testing, and other testing. Radiology is the use of x-rays on the human body and is used to gain an inside perspective of the human body that cannot be obtained from a physical examination. Treatment may include chiropractic adjustments, physical therapy (such as ultrasound,
interferential therapy, massage therapy, exercise recommendations, etc.). Additionally, there may referrals to other doctors as necessary, and their treatment should involve the same informed consent with disclosure of risks and benefits as is being done here. For example, there can be permanent pain as a side effect of surgery as one possible consequence of that procedure.
Potential Benefits of Chiropractic and Associated Care
The vast majority of chiropractic patients tend to achieve good to excellent improvement in their physical conditions with chiropractic care. Improvement can be measured in many different ways, including reduction in pain, increased range of motion, less stiffness, increased athletic performance, and other ways. It must be remembered that different people get different results, different people have different pre-existing conditions, and are of different ages and occupations (with different types of physical stress). Your situation is unique, and no guarantees are given. You will have to determine what results you get for yourself and report them to your Doctor of Chiropractic.
Material risks Inherent with Chiropractic Adjustments and Other Treatment
As with any healthcare procedure, there are certain complications which may arise when chiropractic adjustments and other care/procedures are performed. These complications include but are not limited to fractures of bones, disc injuries, dislocations, muscle strains, cervical myelopathy, strokes, radiation exposure, costovertebral strains and separations, and burns. Some patients feel some stiffness and/or soreness following the first few days of treatment.
The physical exam can temporarily worsen symptoms, but is a necessary part of chiropractic care.
The Doctor of Chiropractic will make every reasonable effort during the examination to screen for contraindications to care, but remember it is your responsibility to inform the Doctor of Chiropractic of any conditions that would not otherwise come to their attention.
Probability of Risks Occurring
Fractures are rare occurrences and generally result from some underlying weakness of bone. Even though a competent history, examination (which may include radiography) will be performed, it is still possible for some weaknesses of bone to be undetected. Extremely rare are strokes from vertebral artery dissection which also occur in about one person in 133,000 in general (not related to chiropractic), but are estimated to occur in between one in one million and one in five million cervical adjustments. Although discs are generally helped with chiropractic care, they canbe worsened even to the point of requiring surgical care (although this rarely occurs). Physical therapy can sometimes burn skin by irritating it, although this is unlikely to occur A perspective on the risks of chiropractic care as compared to medical care can been seen by the money paid by different doctors for a $1,000,000 malpractice liability policy. The following annual premiums listed are close approximations, although not exact. A general medical doctor pays about $20,000 per year, an internal medicine specialist pays about $50,000 per year, and medical specialists such as surgeons, cardiologists, and obstetrics and gynecologists (OBGYN) pay about $150,000 per year for a $1,000,000 malpractice liability policy. In stark contrast to medical doctors who patients encounter significant more risk that Doctors of Chiropractic, Doctors of Chiropractic in California pay about $3,000 per year. Also, it has been reported that about 187,000 deaths occur every year from medical malpractice, but that the number for chiropractic is typically zero per year.
Consequences of Not Obtaining Chiropractic Care
Not obtaining chiropractic care will have the effect of not obtaining its benefits such as having your body function at its best ability, reducing pain, peak athletic performance, etc. Not obtaining chiropractic care may allow formation of adhesions and reduce mobility which may set up a pain reaction further reducing mobility. Over time this process may complicate treatment making it more difficult, requiring more time (and money), and less effective when chiropractic care is obtained later in time. Not obtaining chiropractic care following trauma such as whiplash or other effects of automobile accidents will cause injured muscles, tendons, and ligaments to heal improperly and be significantly weaker and more prone to reinjury as compared to receiving proper chiropractic care.
Alternatives to Chiropractic Care
Other treatment options for your condition may include rest, acupuncture, physical therapy, medical care,
medications (both over the counter and prescribed), hospitalization, and surgery, and others. If you choose to use other treatment options, you should discuss the risks and benefits with your medical doctor or other provider.
By signing below, I am acknowledging that I have read and understand this form.