To request your credit (insurance credit or referral credit), please complete this form. For insurance credit, please note that only the insurance billable portion of your total payments (your office visit fees and test fees) are subject to refund. Your payments for the products (Rx and/or non-Rx supplements you received) are not subject to refund. For example, if you paid $350 for your first visit ($120 for office visit, $50 for the breathing test, $150 for hCG, $30 for various other products). We billed your insurance for your visit and the test. Your insurance paid (the payment maybe greater or less than what you paid). Your credit is calculated as follows:
$120 - your copay/coinsurance - deductible (both described in your Explanation of Benefits).
$50 (Breathing test) - copay/coinsurance - deductible. If your insurance paid $150 to us for office visit, your copay is $15, then your office visit credit is $120 - 15 = $95.
Most Health Insurance Accepted, All Rights Reserved.