A. Healthcare Finance Direct (HCFD) financing
B. Care Credit financing
C. ParaSail financing
D. Youthful Endeavors’ Financial Policy, Part I of II
E. Youthful Endeavors’ Financial Policy, Part II of II
F. Patient Self-Submittal Claim Form, an Explanation
We have the Zero percent financing program available called Healthcare Finance Direct (HCFD). You as a Youthful Endeavors’ Client or even as a Clients-to-Be can go to the HCFD website at www.healthcarefinancedirect.com to prequalify for a loan of any amount greater than $1000 by using Youthful Endeavors’ HCFD Provider #10372.
Youthful Endeavors’ HCFD Provider #10372
We highly recommend this HCFD option especially for larger treatment packages. HCFD is a highly reputable finance processing company especially designed for healthcare customers and our six plus year history of working with them has confirmed they are consistently client friendly and their staff have always been super helpful to our MedSpa staff as they assist us with each of our clients in the completion of their HCFD application paperwork. They are truly business and client supportive in their daily operations and their financing services are the most cost effective financing-of-healthcare-services option in the USA. HCFD loans and their repayment options are good alternatives to direct bank loans, second mortgages options or the option to place large single purchases on high interest-bearing credit cards. Also, a person who decides to undergo another procedure at Youthful Endeavors months after taking out their first HCFD loan can usually take out another HCFD loan before their original loan has been paid off as long as their personal financial situation remains stable.
HCFD’s monthly loan processing charge is $10 per month no matter if your loaned is $1000 or $35,000. No, this $10 per month HCFD monthly processing fee is not a misprint! HCFD is financing company that has been successful and in existence now for over 10 years. The term range of these HCFD loans are for 4 to 36 months and depends on the loan dollar amount and your credit rating. There is an initial $39.95 activation fee that the patient pays directly to HCFD and the patient will be required to pay 10% to 20% down payment directly to our practice, Youthful Endeavors as Dr Hetz is your provider of these planned aesthetic services. Your percentage downpayment is based on your credit history-credit rating. In general, if you or you and your CoApplicant, if desired, have an income of at least $2000 gross per month, and don’t have a any significant bankruptcy history or recent or serious past credit problems, our clients have been consistently approved. This low cost financing program can be provided to most of our clients because it’s the provider (In this case Dr Hetz our board certified surgeon and who is both Medical Director and the owner of Youthful Endeavors Aesthetics) who will be performing or providing your medical services, and thus is who is taking the loan loss risks, and not a bank. HCFD only works with healthcare providers and consumers of healthcare related services. You can’t buy a used or new car with HCFD but you can buy 10 or more years off your look or a better looking or a more pleasant contoured body.
Youthful Endeavors Aesthetics’ Merchant ID# 5348121300563424
We also have Care Credit and that website is www.carecreditpro.com and our Youthful Endeavors Aesthetics’ merchant ID# is 5348121300563424. Care Credit interest rates start at 5.7% and up as these loans are processed through and backed by a banking system. Care Credit costs at least 5.7% more and the interest rate can jump to double digits.
In very select situations we can sometimes offer clients a short term internal loan or repayment plan for care provided much like what medical-surgical practices do when insurance companies don’t pay full amounts for medically necessary procedures or care services.
Finally, we also provide 2.5% discounts on treatment packages that are more than $5000 when treatment packages are paid in full as one lump sum in cash, a cashiers check, or when using a personal check since it is our philosophy to pass on this ~2.5% savings to those clients since Credit Card & Debit Card companies and/or the business’s Bank charges this transaction processing fee to all businesses including Youthful Endeavors.
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Patient Self-Submittal Insurance Claim Form
How can a patient submit a claim to their insurance company while seeing Dr Hetz. (Youthful Endeavors Aesthetics and Women’s Healthcare Associates. Ltd. no longer processes insurance claims as of 05/2017)
Nowadays more and more physicians are choosing to no longer deal with insurance companies and are requiring patients to pay for Services at the time Services are Rendered.
How can a patient who has paid for their office visit up front possibly get paid back for some or all of that money from their health insurance company? A patient can Submit their own Claim for a medical services rendered by a healthcare provider to their insurance company using a Self-Submittal Claim Form that is completed and signed by their physician.
As a courtesy to a patient in good standing at Youthful Endeavors, Dr. Hetz, upon written request from that patient, will help prepare a Self-Submitted-by-the-Patient Insurance Claim, SSPIC, Form for a previous rendered non-cosmetic related medical Service. However, a Self-Submitted-by-the-Patient Insurance Claim Form will not be provided for some Services, at the sole discretion of Dr. Hetz, nor for any Service whose Date of Service was provided 3 or more months ago.
These SSPIC Forms may contain one or more CPT office or procedure code(s) and one or more ICD-10 diagnostic codes, but there is no implied nor stated guarantee being made by Dr. Hetz or any staff member that any offered up codes will be accepted by or usable by the patient’s chosen insurance company. These SSPIC Forms are on Youthful Endeavors Aesthetics-Women’s Healthcare Associates, Ltd’s Letterhead and contain Dr. Hetz’ Wisconsin Medical license number and his National Practitioner’s ID number. The dollar amount for any specific CPT code will be populated with our standard prevailing fees for Services Rendered we consistently use and which are increased-changed once or twice each year to try to keep up with the yearly cost of living percentage increases.
Patients have the sole responsibility to send, by snail mail, email, and/or fax these SSPIC Forms into their insurance company’s Claims Department and to follow their insurance company’s handling and processing to its full completion.
When submitting a Self-Submitted-by-the-Patient Insurance Claims Form it is recommended, and expected, that the patient supply their insurance company a copy of their Receipt for Services Rendered that Dr. Hetz’s office staff supplied him/her at checkout on the date & time that the Service(s) was/were Rendered. This Receipt or Invoice shows what amount the patient paid for each Service, though there may be times where the amount the patient paid was a Discounted-for-Cash-payment-at-the-time-of-Service and thus the dollar amount shown on the Receipt/Invoice will be less than the standard & prevailing fee next to the CPT code on the SSPIC Form.
These SSPIC are simply a helpful-to-the-patient method to assist him/her to be considered for being paid back some dollars by his /her insurance company, but by no means is there any guarantee being made by anyone at Youthful Endeavors or by Dr. Hetz that the SSPIC Forms or the information that the Form was populated will be accepted by or covered by, or paid toward by their insurance company. Any dollar amount, if any, that an insurance may provide payment for or choose not to provide payment will be according to your insurance company’s policy fine print language and their interpretation of that fine print language. These SSPIC Forms will hopefully help allow the insurance company to determine if the Services Rendered by us at Youthful Endeavors to accept the submitted CPT codes with the adjacent ICD-10 codes as a covered medical care expense.
It should be expected that any level of insurance payment will be according to the fact that Dr. Hetz is an out-of-network Healthcare provider. The patient’s insurance company will unilaterally determine what Service or office visit charge will be rejected or not accepted as well as which part of the Service charge will go toward the patient’s Co-pay and what dollar amount goes toward the patient’s yearly out-of-network deductible or in-network deductible. The patient’s insurance company will determine what dollar amount of the SSPIC Form’s listed fee, if any, will be allowed as their usual and customary fee or the accepted-by-them fee that they will make their own calculations off of.
Once the insurance company finds all their ways to cancel or reject the dollar amounts provided on the SSPIC Forms they will decide what dollar amount they will or will not distribute to the patient, usually via a check and mailed, to the patient, not to the provider, Dr. Hetz, who provided the Service. Because the patient paid for the Services Rendered at the time of his/her visit, the patient is not expected to pay this office any additional money for that particular Service listed on the SSPIC Form, even if the Insurance company designates on the Estimated Of Benefits, EOB, print out that the patient is responsible for paying the Co-pay and/or a co-insurance amount and/or deductible amount.
Financial Policies of Youthful Endeavors Aesthetics
Financial Policy Part I of II:
Insurance Billing for Youthful Endeavors Aesthetics which is a DBA of Women’s Healthcare Associates. Ltd.
(as of 03/16/2016)
- As a courtesy to our Clients/Patients (C/P), we may call your insurance company to verify C/P’s health benefits. C/P must understand that verification of benefits does not guarantee payment by C/P’s nsurance carrier. Lesion(s) removed are not always covered by insurance plans including ones that are removed for cosmetic reason and those are not clinically suspicious for precancerous changes or cancer. Insurance may not cover pathology analysis by Pathologist/Doctors of those lesions and other tissue specimens but the patient remains responsible for those charges .
- As of 3/21/16, Youthful Endeavors(YE) and Dr Hetz will continue seeing patients for medical problems/care who have health insurance coverage but this care will be paid at the time of service at a ‘at the time of service’ discount of $125, with extended visits costing up to $375.
- Patient will be encouraged, and helped to complete and send into their own insurance company, a prepared-by-Doctor Self-Submittal form of their care rendered by YE/DrHetz. Depending on a patient’s health insurance or health coverage plan, Dr Hetz will provide the patient with a completed and signed by Dr Hetz Patient-Self-Submittal-To-Her/
His-Insurance-Company Form. As part of the Self Submittal process, the patient must send to their insurance company in the hope that the patient is pay by his/her insurance company according to their ‘usual and customary’ level of payment for services rendered. The patient payment from his/her insurance company may be zero dollars or more than the $125 the patient paid YE at the time of services rendered. Insurance payments should be based on the patient’s insurance plan’s language and based on the provider’s (Dr Hetz‘s) chosen CPT codes that represent the procedure/medical services provided/rendered, the ICD 10 diagnostic codes provided by Dr Hetz, and the dollar amounts of the Dr Hetz‘s prevailing standard fees will be provided by DrHetz on the prepared Self Submittal form for each service rendered. DrHetz‘s specialty fees are considered standard acceptable prevailing fees for similar Specialist practices, and are customary fees for the Midwest medical communities.
- Payment for services provided by Youthful Endeavors, a DBA of Women’s Healthcare Associates, Ltd is the sole responsibility of the C/P and/or the C/P’s parent or guardian. Health insurance does not relieve C/P of their financial responsibility for services rendered. Cosmetic Services & some medical treatments procedures, like acupuncture, are not covered by insurance companies or State and Federal Health programs, including Medicaid, Medicare, Forward Health/ Badger care, etc.
- C/Ps need to understand that They(C/Ps) are still financially responsible for all fees & charges not covered by C/P’s insurance plan(s) and charges in excess of benefits paid under such plans. C/P will still be responsible for any services that their insurance company happens to decide to process a service rendered by Youthful Endeavors, the physician, and/or Nurse, as “non-covered” benefits.
- Patients wishing to schedule an initial Acupuncture consultations and/or treatment must put forth a $75 scheduling-consultation fee on his or her Credit Card or make a Cash payment BEFORE their appointment date and time are made/set. This is due to the reality that such C/P have shown in the past to not show up for their appointments for insurance non-covered medical care services. However, that $75 can be applied to the C/P’s first acupuncture treatment session but it is nonrefundable even if the patient chooses to not undergo acupuncture or trigger point treatments.
- C/P is expected to understand that he/she will remain responsible for charges for all services rendered even if C/P’s insurance company requires prior authorization for services and prior authorization was not received.
- C/P is expected to understand that it is C/P’s responsibility to help get their insurance company to pay for services rendered. C/P should take an active roll in handling insurance collections by sometimes calling their insurance company to prompt them to pay if necessary and return any questionnaires they send the C/P in a timely manner.If C/P’s insurance company does not pay in full within 60 days from the date of service, C/P acknowledges the requirement that they(C/P) will remain responsible for any amounts owed and C/P is expected to make payment in full at that time.
- C/P understands that part of fairness and appropriateness, that C/P will be refunded by Youthful Endeavors when/after C/P’s insurance company pays Youthful Endeavors/Women’s Healthcare Associates, Ltd.
- The minimum monthly payment for a bill received for services rendered is $50.00 per month or 10% of the bill, whichever is more.
- Missed appointments. When C/P reserve an appointment time, it is not available to other clients. Therefore, we ask for advance notice of cancellation. Your insurance company will not pay the $50.00 missed appointment charge if charged to the C/P for repeated missed appointments. We reserve the right to require a $75 credit card down payment for patients who miss scheduled appointment without contacting our office in advance.
- If referred to this office by another healthcare provider, under HIPPA we have the permission to contact that provider for medical records and any additional information necessary for treatment and payment.
- There is a $25.00 fee per form for the office to fill out and complete required insurance forms (i.e. Short Term-Disability, FMLA, Credit Card Deferred Payment forms, etc.)
- If a check submitted to this office for payment is returned from the bank for non-payment, you will responsible for the $35.00 NSF fee in addition to the check amount.
- All elective procedures must be paid in full or have 10% down payment submitted to Office before the procedure is scheduled. A 10% down payment once received by the office will also secure pricing/Quote and hold discounts for one year. Payment Plans or method of payment must be set-confirmed and completed by the day of her/his preoperative appointment in order to keep the procedure on the schedule as originally planned. Youthful Endeavors/Women’s Healthcare Associates, Ltd does participate with Healthcare Finance Direct and Care Credit; please inquire at the front desk for more information. In hardship cases, we reserve the right to offer and execute internal payment plans for patients whose insurance does not cover expenses for services rendered.
- Routine Post Operative Care services are covered for a period of days to a few weeks depending on the type and number of procedures performed. Some types of post op medical and/or additional surgical care to treat unexpected complications or problems are chargeable events and are not included in the fees/charges or the price paid to have the original procedure. These unexpected additional care and/or procedures-treatments fees remain the responsibilities of the Patient/Client and these Medical-Surgical care fees can also be submitted to the P/C’s insurance carrier by the P/C via a self-submittal form available and filled out/completed by DrHetz/staff. at Billing insurance can be done for some of these medical and surgical care services provided by Dr Hetz and Youthful Endeavors whether or not Dr Hetz is an Out-of-network provider or In-Network provider for the patient’s designated insurance company; but this submission of charges to the insurance company does not mean the patient’s insurance company/provider will pay for such services. The modern day reality of insurance companies and other health plans transferring responsibilities for payment for medical services rendered onto the shoulders of the P/C, requires the P/C to understand that they, the P/C, remains responsible for the charges for these services rendered even if left they are unpaid or uncovered according to the insurance company’s decisions.
- For additional financial policy issues, please refer to Part II titled, ‘Policy on General Medical Care, Surgical Care, Aesthetic/Cosmetic Care, Pre-Op & Post-Op Care at Youthful Endeavors.
Financial Policy Part II of II:
General Medical Care, Surgical Care, Aesthetic/Cosmetic Care, Pre-Op & Post-Op Care
(as of 03/16/2016)
General Medical care is part of the Services provided by our physician/surgeon and nursing staff. Not all Services we provide are aesthetic or cosmetic in nature. It is typical and standard practice throughout the USA, that Aesthetics/Cosmetic treatments and procedures are NOT covered by insurance or health plans.
Aesthetic Surgical care that are part of your paid care includes PreOp visit(s) that can include discussions and consultation and limited/extended physician examinations. These are real parts of your care that are part of the price of the stated fee of a procedure. For example, the stated $3575 cost of a classic liposuction procedure on the upper/lower abdomen with IV Sedation, includes the $175 cost of the pre-op visit/exam ($175 per hour of care) and the fixed & variable costs of clerical and nursing staff’s time to preparing/scheduling supplies operating room, & staff as well as clerical staff time for processing the patient’s financing and typical clerical and nursing operations that are much more involved in preparing patients for surgery than a simple office visit.
As an example, if a patient decides to not to undergo a scheduled $3575 liposuction surgery days before the scheduled surgery, and chooses to not to have the scheduled procedure within the next six months or ‘never’ automatically forfeited any and all package or Special discounts with that package. Any designated dollars prepaid toward the canceled surgery/procedure previously will be returned or credited(within 45 days of the patient’s verbal or written notification of our physician or Practice Administrator) BUT minus the $175 the preoperative care, any significant Office Visit care provided at or after the pre-op appointment, a 5% transaction reversal/processing/handling fee, a 10% to 25% restocking fee of any planned-to-be-used perishable products or specially ordered supplies, and any operating room & anesthesia staff-securing costs or fees that the practice has incurred.
If these canceled procedures, treatments, and/or surgical procedures were part of a prepaid package of treatments, then any and possibly all discounts on previously performed treatments, procedures, and products sold are automatically voided and are forfeited by the Client/Patient. It must be understood that discounts provided by this practice and those placed into package deals are special circumstances being offered to the Client/Patient and changes in the removal of portions of the package deal does change the discounts status within the entire package that was originally sold to the Patient/Client.
Thus the dollar amount calculated from the procedure that the patient prepaid and decided not to receive or move forward with will be returned to the Client/Patient MINUS any discounts within the original prepaid package. The alternative to taking this path of ‘requesting a refund’ on unused & prepaid package treatments-procedures (If the patient or physician decides for any reason not to undergo a specific treatment or procedure that was part of total treatment package) is for the Patient to use ‘the unused procedure value’ toward a different Service(Not Product) at Youthful Endeavors.
In summary, If the Patient/Client desires or requests to be paid back any monies due to her/his decision or if the patient’s actions or conditions cause the cancelation of prepaid Services, irrespective of the reason(s), this cancelation or his/her request to be refunded back monies associated with unused prepaid Services/Products essentially causes the Package’s Specials and/or Discounts to be voided. Thus, the Services that have already be performed/rendered will be repriced out at their standard price/fee without adding their individual or collective Discounts and Specials dollar amounts off.
For example, if the patient buys a combination procedure package that includes a $6500 facial laser & Botox skin rejuvenation procedure (Step I) and also a $3850 liposuction on her Neck & Jowls procedure (Step II) and she completed Step I and decides not to even have Step II, then her $150 laser discount is voided and the $144 Botox package discount is voided, and a 5% transaction/processing fee ($192.50) on the $3850 is assessed. Therefore, the amount to be returned is $3850.00 – $150.00 – $144.00 – $192.50 = $3365.50.
Another example is when a patient buys a BellaFill skin filler treatment package that includes 15 syringes that involves two injection sessions 4 to 6 months apart with the first injection involving 9 syringes and then 6 syringes is planned during the second injection session 4 to 6 months later. If she decides to not ever have the second injection and choses the option to be paid back for the used 6 syringes, then the $290 OFF per syringe (if 10 or more syringes are purchased) discount is removed from the original treatment package. The the net amount of monies that will be returned to the patient would be the amount paid for the amount paid for Step I & Step II of the BellaFill package minus the $290 discount provided for the first already 9 injected syringes and minus the discounted price of the remaining 6 un-injected/unused syringes of BellaFill. There is also a Restocking Fee of 10% to 25% on all perishable supplies like Skin Fillers and fat transfer solutions like Selphyl. Also, a 5% transaction reprocessing and/or a handling fee will be assessed on the returned money amount and/or on any amount paid by Credit Card toward the the Service that the Client/Patient does not receive or choses not receive for ANY reason.
Post-op care include care for helping assist recovery from the primary procedure(s). However, complications, or what some want to coin as acts of God or unfortunate bumps in the road to a better you and they can arise from, or as the result of, your procedures and what you chose to do and not to do following a procedure. The treatment of complications and any return to surgery technical-surgeon-physician fee and supplies or medications-prescription drugs are not part of the services within your prepaid treatment/procedures package. Likewise, if you need emergency room care or additional or unexpected surgery at a hospital or out patient or office setting, those times of extra care service are not covered as part of your prepaid care package, and whether or not Dr Hetz provides or doesn’t provide that care. A good example is if a woman has a hysterectomy for fibroids/abnormal bleeding and her insurance covers their normal percentage of Doctor fees, hospital Operating Room charges and post surgery nursing and recovery room & post surgical floor charges for three days. If that woman then unexpectedly develops a pelvic abscess one week post op and goes to the emergency room expense mount up and are billed out by the doctor and hospital for their services. That woman then needs to go back into surgery under general anesthesia to remove and drain the abscess and then requires 10 days more in the hospital. This compilation and additional care by multiple professionals cost include blood tests, CT scans, ultrasounds to diagnosis, surgical & post op nursing staff, OR room supplies, antibiotics. It is standard practice and accepted and understood that these charges and fees are the ultimate responsibility of the patient and hopefully the person’s insurance company or health insurance plan covers the majority of the unexpected healthcare services expenses. Example of treatment or healthcare services not covered as part of your prepaid treatment-procedure packages or during-before-after the course of other Aesthetics treatments and Services include:
- Office visit to treat acne, Rosacea, a medical skin condition, a medical condition like obesity, depression/anxiety, or smoking cessation.
- Office visit time or professional time before or after an office visit to review medical records and/or medical history and where the doctor has provided a clinical opinion, or provides a patient a suspected diagnosis, and/or provides a patient recommendations on a treatment or a treatment approach.
- Office visit to follow up on the treatment response to therapy and especially when there is a need to prescribe further therapy, further evaluation recommendations and/or orders for blood tests, X-Rays, and/or prescription medications. These charged office visits are also standard to be chargeable visits when side effects of treatments are encountered and when care/treatment or instructions to the Client/Patient are needing adjusted.
- Surgical Debridement of a wound or infected incision
- Office visit when a prescription for an antibiotic for an infection develops
- Office visit for treatment for chronic pain conditions
- Office visit for new treatment prescribed for newly-diagnosed anxiety, depression, hormone imbalance
- Surgical drainage of post-op fluid collection/Seroma
- Post-op Radiofrequency, Class IV laser, or Ultrasonic treatments for treating bruising, help reduce scarring and lumps or swellings.
- Injection and costs of Steroid drug for allergic reactions, post filler inflammatory lumps/granuloma
- Injection and costs of drugs like Toradol (anti-inflammatory and pain drug), antibiotics, Narcotics, sedatives, IV/IM infusions of therapeutic drugs
- Office visit to discuss and/or to treat new medical problems that develop during the 2 to three month post op period whether the condition is related to the recently performed procedure(complication) or unrelated to a recently performed procedure.
- There are situations and conditions that care may be provided for free or at a reduce cost.
- Dr Hetz/Youthful Endeavors, a DBA of Women’s Healthcare Associates, Ltd, will only submit office and procedure services HCFA bills to Prevea 360 and Medicare for nonCosmetic services rendered.
- For most Office Visits discussions where treatment advice, diagnostic tests are ordered, and/or treatment prescriptions are written/ordered, there will be a $125 Office charge that is to be paid at the time(the day the service is rendered) and completion/end of that visit. There are situations where the office visit fee would be $75. There are procedures and treatment that can be less than $125 or more than $125 but are expected to be paid at the time of the service.
- Depending on a patient’s health insurance or health coverage plan, Dr Hetz will provide the patient with a completed and signed by Dr Hetz Patient-Self-Submittal-To-Her/His-Insurance-Company form that the patient herself/hisself sends to their insurance company for the patient to pay the patient based on the provided CPT procedure/medical services provided codes, the ICD 10 diagnostic codes, and the prevailing standard fees of the practices that are the usual and customary fees for the area as determined by Dr Hetz’ office.