Diamond Touch Functional Medicine Out-of-Network (OON) Policy
Last update: January 2025
Overview
At Diamond Touch Functional Medicine, we are committed to providing exceptional care and transparency regarding billing and insurance practices. This Out-of-Network (OON) policy outlines how we handle services provided to patients with insurance plans that do not include Diamond Touch Functional Medicine as an in-network provider.
Scope
This policy applies to all patients receiving services at Diamond Touch Functional Medicine and explains how out-of-network billing and reimbursement are managed.
What is Out-of-Network (OON)?
Out-of-network refers to providers or facilities that do not have a direct contract with your health insurance plan. Receiving care from out-of-network providers may result in higher costs for patients.
Patient Responsibilities
Patients are responsible for understanding their insurance benefits, including:
● Whether Diamond Touch Functional Medicine is considered an in-network or out-of-network provider.
● The extent of out-of-network coverage and potential out-of-pocket costs.
● Any deductibles, copayments, or coinsurance that may apply to out-of-network services.
Billing and Payments
For patients with out-of-network benefits, Diamond Touch Functional Medicine will provide the necessary documentation to submit claims to your insurance provider for potential reimbursement. However:
● Payment is required at the time of service.
● Reimbursement rates vary based on your insurance plan’s out-of-network policies.
● We cannot guarantee full or partial reimbursement from your insurance provider.
Good Faith Estimates
In accordance with federal and state transparency laws, Diamond Touch Functional Medicine provides good faith estimates of anticipated charges prior to services being rendered. These estimates are not binding but are meant to offer clarity regarding potential costs.
Surprise Billing Protections
Patients are protected from surprise medical bills under New Jersey’s Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act.
This means:
● For emergency services, patients cannot be billed beyond their in-network cost-sharing amount.
● Patients receiving non-emergency services at in-network facilities will not be responsible for out-of-network charges if they did not choose the out-of-network provider.
How to Minimize Out-of-Pocket Costs
To minimize costs and avoid unexpected bills:
● Verify if your insurance plan includes out-of-network benefits.
● Contact your insurance provider to confirm coverage details.
● Speak with our billing team before receiving services to discuss payment options and estimated charges.
Contact Us
If you have questions regarding this policy or need assistance with out-of-network billing, please contact Diamond Touch Functional Medicine at info@diamonddtouchmedicine.com or call our billing department at [insert phone number].
Policy Updates
This Out-of-Network policy is subject to periodic updates to reflect changes in regulations and internal practices. Please review this policy regularly to stay informed of any updates.