Insurance Billing Policies

At Lavender Spectrum Health, we are committed to providing you with the best possible care and ensuring that our services align with the policies set by insurance companies. We bill insurance as a courtesy to you and in line with our values of being as accessible as possible to as many patients as we can. That being said, we need your assistance in understanding your insurance policy and benefits to reduce your risk of getting unexpected bills and creating financial hardship. 

In order to continue delivering high-quality care and to comply with insurance guidelines, we want to explain common billing issues and request your cooperation.  

We kindly ask that all patients decide no later than the beginning of their visit whether they are being seen for a wellness visit or a problem visit and communicate this with the provider. It is important for patients to understand the distinction between these types of visits, as it directly impacts the services provided and potential charges incurred. 

Wellness Visit: During a wellness visit, our healthcare providers will focus on preventive care, health maintenance, and overall well-being. It is important to note that addressing any health problems, such as prescribing medications, ordering tests, or making referrals, during a wellness visit is not included in the scope of this appointment. If health problems are addressed during a wellness visit, additional charges may apply as per the policies set by insurance companies. 

Here is a list of what is commonly included in preventative visits: 

• Blood pressure screening 

• Mental health screening 

• Screening for problematic drug/alcohol use 

• Discussion of physical movement / exercise habits 

• Discussion of eating patterns to promote wellness 

• Screening for immunizations needed 

• Screening for cervical cancer 

• Screening for breast cancer 

• Screening for colon cancer 

• Screening for sexually transmitted infections in people without symptoms

If an insurance company pays for one annual wellness visit, they will typically only pay for one preventative visit in a year. If you want an additional preventative visit such as a separate sports physical or standalone gynecological screening for cervical cancer or sexually transmitted infections, these visits may not be covered. We recommend contacting your insurance company if you have questions about your policy.

Problem Visit: If you are experiencing specific health concerns, symptoms, or require medical attention for a particular issue, your visit will be classified as a problem visit. During a problem visit, our healthcare providers will address your health issues, prescribe medications if necessary, order tests, and make referrals as appropriate. 

Some examples of problem visits include (not all inclusive): 

• Diabetes 

• High blood pressure 

• Depression 

• Hypothyroidism 

• ADHD 

Many insurance companies have exclusions for covering specific services such as mental health or weight loss counseling or medications. If your insurance company does not cover these visits and no other issues are addressed during your visit, you will be responsible for the cost of the visit. 

Many insurance companies will refuse to pay for specific blood tests or blood tests for a specific diagnosis. It is your responsibility to figure out your coverage for blood tests prior to having them drawn or you will be responsible for the costs. We are happy to provide you with a list of diagnoses and lab test codes for you to figure out what your insurance covers if you ask.

While we do our best to recommend specialists, imaging facilities, urgent care facilities, and laboratories who are in network with many insurance companies, we recommend you contact all outside providers and facilities before you go to ensure they are in-network with your insurance.  If your insurance is not in network with a facility we recommend, we may request your assistance in finding facilities that are in network with your insurance. 

We also recommend contacting your insurance via phone or via web directory prior to your visit to ensure our providers are in network with your insurance. 

It is also your responsibility to know what your financial responsibility is if any for your healthcare, including co-payment, co-insurance, and deductible. If you find out after a visit that you have not met your deductible and are billed for the cost of the visit, we are happy to help make a payment plan with you, but cannot waive the cost because you were not aware of your deductible. 

Co-pays are due at the time of your visit, and will be collected at the end of your visit if they were not paid on the portal prior to your visit. 

Late cancellation fees and no-show fees are due within 30 days of your visit, and if you do not pay these fees, you may be unable to schedule a follow up appointment until these fees are paid. Late cancellation fees and no show fees do not apply to patients who are insured by Medicare or WA Medicaid/ Apple Health. 

While we do not send patients to collections, if you do not pay your balance within three months of the date of service assuming there have not been billing errors, this may affect your ability to schedule follow up appointments.  Please bring any billing errors to our attention as soon as possible and we will do our best to remedy them as quickly as possible. 

We understand that this policy may raise questions, but it is important to emphasize that this policy is aligned with the policies set by insurance companies. By adhering to these guidelines, we can continue to focus on delivering comprehensive care and ensuring that our patients receive the appropriate services during their visits. We appreciate your cooperation and understanding as we implement this new policy. If you have any questions or require further clarification, please do not hesitate to contact our office. Thank you for entrusting us with your healthcare needs.

Existing patients may pay their bill via the patient portal below: