Register with Aspire Wellness | Jennifer Paulson NP, PC

Jennifer Paulson NP, PC EIN 47-2245016

Aspire Wellness

Welcome to our functional and integrative medicine practice. We take pride in the high level, holistic care we offer, which is above the traditional standard of care. These policies help us to be able to bill insurances for our functional medicine care. Please take the time to read through our office and financial policies to understand our unique structure, offerings, and expectations.

Office Policies & Guidelines

We are a micro-practice model. This means that we operate with a low overhead to allow more time for patient care and support a healthy work-life balance for our practitioners. Our primary method of communication is the patient portal. Our office phone serves as text and voicemail only. We aim to return calls/texts within 1 business day. Our portal is set up for you to do everything you need to do-schedule, cancel appointments, pay your balances or we collect your balances to your card on file, portal messaging to our team, viewing labs, documents, and handouts, tracking vital signs and health data.

Active Participant. We expect our patients to be the driver of their health and wellness journey. This means you come to your visits prepared, are eager to learn and understand your labs, plan of care. Our providers share their knowledge and serve as your guide. We love to educate and empower our patients for health and wellness.

Billing Model. We are structured as a fee-for-service clinic meaning we bill for provider's time for all services. This is the structure of an insurance-based billing practice. We do offer a 25% time of service discount for those who do not have insurance or wish to not use their high deductible insurance plans.

Insurance Billing. We expect you to know YOUR insurance benefits for office visits and laboratory/blood draws.

Membership Offerings. We offer a membership plan, which serves to provide care to you in between office visits (portal messaging) along with other benefits. Membership is billed month to month, requires an initial 6-month commitment, and then you may cancel at any time. (Please see membership contract and website for details).

Primary care services. Dr. Paulson offers limited primary care services and mostly works as a functional medicine specialist. If you want primary care services, you must discuss with her to ensure she can meet your primary care needs.

Prescription Refills. You agree that your prescriptions will be renewed during office visits and should you need a refill outside of a visit, there is a $35 fee (automatically applied to your card on file) for your Provider to do this. This fee is waived for members.

Supplements/Vitamins. The cost of supplements are not covered as part of office visit charges. It is your choice to choose where you buy your supplements from. Our company does make a small profit from online supplement sales. We offer every patient a 10% discount and our members receive a 20% discount. It is your responsibility to check the ingredient list to ensure you do not have an allergy to the supplement recommended to you. We cannot accept refunds for supplements purchased in the clinic.

Lab Orders. I acknowledge that lab orders will only be completed during office visits. Labs are ordered only for patients who are working with our providers directly on a health plan. We reserve the right to refuse ordering a test that is not medically necessary or out of her scope of practice.

Review of your medical records. I acknowledge that there is a fee for my provider to review my medical records from other doctors outside of a scheduled visit. We do not routinely request medical records from your other providers as their labs and information rarely impacts our decision making. We expect patients to share any recent (less than 6 months) labs via the portal if it is something you want us to consider in your upcoming visit. Our charge is $50 per 15 minutes of record review. This charge does not apply for patients who have worked with Dr. Paulson at another clinic and transferred care here to her private practice.

Administrative paperwork. I acknowledge that a 15-minute office visit is needed for FMLA, school/work notes, medical necessity letters requiring a providers signature. If this is something you need, please be sure to request this need and have the paperwork at the time of your office visit.

Portal Messaging. You are not charged to route billing or scheduling questions to our other team members. Members have access to portal message Dr. Paulson and will get a response within 24 hours Monday-Friday 9am-4pm. Non-members will incur a $35 portal consultation fee for any medical questions sent to Dr. Paulson. I also understand that all staff can see my portal messages.

Accessibility to Lab Reports. Per the Cures Act put into effect on April 1, 2021 all labs will be made viewable on the portal upon receipt by our EMR. Please feel confident that our policy is to reach out to patients with any critical lab values. We encourage you to discuss these results with your provider at your scheduled follow-up prior to beginning any new or modified treatment. *If you modify your prescription dosing based on your own interpretation of your lab results, you may be dismissed from our practice*

Financial Policies & Expectations

Credit Card on File: We require a credit card on file in order to book and hold visit times for you. This credit card is stored in our secure system and we cannot see your full card number. Your card is conveniently used to pay for copays, coinsurance, deductible, membership fees, past due amounts and non-covered insurance costs. You have the option to update your credit card on file.

Late Cancel/Missed Appointment Fees: Out of respect for our practitioners and other patients, it is our policy to charge your card on file for late cancellation (48 hour notification) or missed appointments as follows: New Patient $200, Follow-up $100. Our scheduling system sends out reminders for your visit so please pay attention to them for accuracy in date/time. If you show up late to your appointment, your practitioner will use the allotted time left, but you may be asked to reschedule at the practitioner's discretion.

No Insurance: For patients who do not have insurance or have a high deductible plan and wish to bypass insurance billing, we offer a 25% time of service discount. Our fees are disclosed in our Good Faith Estimate (GFE) document under Questionnaires.

Payment due at time of service: It is the policy of Aspire Wellness/Jennifer Paulson NP, PC that payment is due at the time of service unless other financial arrangements are made in advance. We require all patients to pay their deductible, copay and/or coinsurance payment at each visit.

Outstanding insurance balances: It is our policy to charge any outstanding balances to your card on file after we receive your insurance EOP (Explanation of Payment). If there is a balance due, we will automatically charge your card on file. Any credits due to you over $50 will be credited to your card on file. Credits under $50 will be held as a credit on file to use for future visits.

Time-based service charges: Aspire Wellness/Jennifer Paulson NP, PC bills for services based on time spent for your care and the complexity of your visit. This includes visit prep, review of labs, review of records, one-on-one visit time, and post-visit work to wrap up your plan. Our time ranges are reflected on the GFE statement. i.e. a 30-minute visit is often 40-50 minutes of provider time so it is billed accordingly.

Your Insurance Contract & Responsibilities: Your insurance policy is an agreement between you and your insurance company. As a courtesy to you, we will verify your benefits with your insurance company and will bill your insurance company for your visit.

Verification of benefits is not a guarantee of benefits or payment. You are liable for all fees not covered by insurance. We will not dispute insurance denials, it is your responsibility to do so. If a claim is denied, the charges become your financial responsibility. We highly recommend you also contact your insurance carrier and check into your coverage for primary care services with Jennifer Paulson NP, PC (Tax ID 472245016).

I understand that our office does not bill out-of-network insurance companies or secondary insurance plans.

Insurance Claim Denials. If your insurance claim is denied for any reason, the balance for that service becomes your responsibility. We are not liable for denied claims. We will notify you via an email and portal message to discuss prompt payment of this balance due. You will need to work with your insurance company or employer to advocate for prompt claim processing and payment.

Common reasons we see for denials: you did not pay your monthly premium, your employer did not pay the insurance premium timely, your plan is inactive or our office was not given proper information, or your provider is not a preferred provider with your network/insurance plan. This is always a frustrating situation, we will work with you, but do reserve the right to bill your card on file should you not cooperate with our billing team with a plan for timely payment or insurance re-processing.

Lab Billing: Our default billing for functional lab testing is patient pay. We have found that insurance companies do not find medical necessity in checking many of the labs we need to see in order to optimize your health and wellness. Therefore, we have agreements with labs for cash pay lab panels ranging from $275-$400 (individualized to your history and exam). If you request your insurance to be billed for your labs, you take full responsibility for the lab bill. (It is not uncommon for insurance to deny a Vitamin D level and the patient pays $200+ for that one test).

Professional Service Fees for Non-Members: I acknowledge that the following fees will be charged to my card on file if I am not enrolled in the membership: Portal messages about my health/plan of care, refills outside of an office visit, remote patient monitoring to review your health data (CGM, BP, HRV, etc) prior authorizations for insurance coverage, FMLA/administrative insurance paperwork. These are services that require at least 10 minutes of a providers time and insurance companies do not reimburse for it currently. You can avoid most of these fees by scheduling an office visit for your concerns/needs.

Informed Consent for Diagnosis and Treatment:

The intent of this consent form is to help patients, clients, and authorized representatives become better informed so that they may give or withhold consent to undergo diagnosis and treatment after having the opportunity to discuss health concerns, including potential benefits, risks, and treatment alternatives.

I acknowledge the opportunity to read and inquire about this consent and all the items addressed herein and hereby authorize and associates/contractors, in accordance and within the scope and limits of their clinical license, to perform or recommend any of the following procedures for diagnosis/treatment:

• Office Locations: You consent to treatment at this office (or any other satellite office under common ownership).
• Common diagnostic procedures: such as venipuncture, x-rays, laboratory, ultrasounds, imaging tests
• Alternative Diagnostic Procedures: including diagnostic methods, functional laboratory testing, and devices that may fall outside the "conventional standard of care".
• Medical Nutrition: therapeutic nutrition, nutritional supplementations, and intramuscular vitamin a, mineral, amino acid, lipid, phytonutrient, and metabolite precursor and other nutrient injections, as permitted by licensures.
• Botanical Medicine: medicinal herbs and plant derivatives prescribed as loose teas, alcohol or glycerine tinctures, capsules, tablets, creams, suppositories, etc.
• Intravenous Therapies: including high-dose vitamin, mineral, amino acid, lipid, botanical, and other nutrients.
• Minor Office Procedures: wound dressing, ear cleansing, sutures, biopsies, holistic pelvic care, pelvic exams.
• Physical Medicine: massage, stretching, exercises, yoga, hot/cold applications, and manual or instrument-assisted joint mobilizations, as permitted by licensure.
• Lifestyle and Wellness Counseling: to promote improved wellness through lifestyle strategies, including recommendations for dietary changes, sleep, exercise, stress management, work-life balance, self-care, and developing and nurturing healthy relationships. This excludes specific treatment for known or suspected mental illness.
• Prescription Medications: as allowed by the clinicians licensure and for both FDA-approved and non-FDA approved (i.e. "off-label") applications.
• Hormonal Replacement: oral, transdermal, injected, or device-implanted hormonal applications intended to restore symptomatic patients to levels at or above age-appropriate hormone levels through bioidentical, synthetic, and animal-derived preparations.
• Group Counseling & Coaching: to facilitate efficient and effective community creation and education regarding the diagnosis, treatment, and management of health concerns and ongoing health education.

Informed Consent:

Patient or Representative acknowledges the right, opportunity, and responsibility to ask questions and to become informed regarding the clinician's diagnostic and treatment recommendations to his or her satisfaction. The patient acknowledges that all questions asked have been fully answered by the clinician.

Potential Risks: Patient or Representative acknowledges and accepts that there are risks to the diagnosis and treatment measures that fall within and outside the conventional standard of care and that these risks may include: unintended exacerbation of symptoms, new symptoms, allergic and other unintended injury and side effects from exercise, lifestyle modifications, dietary modifications, herbal and nutritional supplements, injected or intravenous therapies, hormonal therapies, adverse interactions with drugs, herbs and/or nutrients. The specific risks associated with the proposed procedures have been explained to the patient and/or the patient's representative.

No Guarantee of Potential Benefits: Patient or Representative acknowledges that treatment may result in the restoration of health and optimal functional capacity, relief of pain and symptoms, injury and disease recovery, and prevention or reversal of disease or disease progression, but ALSO acknowledges that no expressed or implied guarantees or representations can or have been made by the clinician or any affiliated staff regarding the cure or improvement of the patient's condition.

Limitations of Full Disclosure: Patient or Representative acknowledges that the clinician cannot know or anticipate and explain every possible risk or complication, and that the patient or representative willingly chooses to rely on the clinician to exercise their best judgment within the bounds of their licensure for any of the above.

Responsibility to Report Possible Pregnancy: Patient or Representative agrees to alert the clinician should she suspect that she is or may be pregnant in acknowledgment that some of the diagnostic or therapeutic techniques could present risks to a pregnancy.

Disclosure Coverage: Patient or Representative acknowledges and agrees that consent form will cover the entire course of treatment for the present condition and for any future condition(s) for which treatment is sought.

Willing Participation: Patient or Representative understands that the patient is free to discontinue participation in any and all aspects of the medical care provided by the clinician at any time and that the patient or representative is responsible for informing the clinician of the adherence to or discontinuation of any and all aspects of care and that the choice to discontinue treatments may create the risk of adverse effects for which the patient or representative bears full and sole responsibility.

Clinical Collaboration: Patient or Representative understands that the clinician may consult with preceptors, clinical student residents, and colleagues related to the care provided and that the patient or the patient's authorized representative have the right to decline their presence or involvement during any aspect of the patient's care.

Agreement to Be Contacted: Patient or Representative understand and accept that the clinician or affiliated staff may contact the patient or representative (e.g., by phone, email, voicemail, SMS text message) to consult or exchange information related to the patient's care.

Remote Consultations: Patient or Representative at times, consultation may be provided remotely and without direct contact with the clinician. In such cases, the patient or their representative agrees to maintain direct contact with a licensed healthcare provider that is appropriate for the patient's age, gender, and known or suspected health conditions Medical Record Keeping & Privacy: Patient or Representative understands that records of the health services provided will be kept for a minimum of three, but no more than ten years after the date of the last visit or consultation. The patient or representative also acknowledges that information within the record may be analyzed for research purposes and that in such case, the patient's identity (name, address, exact birth date) will be kept confidential.

Otherwise, this record will be kept securely and confidentially and without release to others unless so directed by the patient or representative, or as may be required by law or as necessary for insurance claim or other payment processing.

Patient's Responsibility to Disclose Information: Patient or Representative understands that the patient bears full responsibility for any adverse effects experienced during or after the course of treatment that were reasonably deemed to be caused or related to a deficit in the full, accurate, and timely disclosure of symptoms and other medical information to the clinician to the best of the patient's or representative's ability.

Responsibility for Payment: Patient or Representative understands that some or all of the recommended diagnostic and treatment measures may fall outside the conventional standard of care and may not be approved or covered by the patient's insurance because the services rendered fall outside the "standard of care," and in such event, that the patient accepts full responsibility for all associated costs and fees.

Dispute Resolution: Patient or Representative agrees that short of overt negligence or malpractice, that any complaint or dispute that arises related to the diagnosis or treatment from clinician will be settled through binding mediation in the state in which the clinician is licensed.

Assignment of Benefits (Insurance/Third Party Billing): I hereby assign benefits for medical services, which I am entitled to. I hereby authorize and direct my insurance company to issue payment to Jennifer Paulson NP, PC for services provided by Aspire Wellness, Dr. Jennifer Paulson, FNP and associations/contractors to me and/or my dependents.

I have read the above office and financial policies. I also understand these policies may be amended.