Payment Policy
Financial Responsibility
You are financially responsible for all services you receive at Sustainable Alignment. This responsibility applies regardless of insurance coverage, membership in a discount association, Medicare beneficiary status, or any other payer relationship.
If insurance or any third-party payer does not pay for a service for any reason, including non-coverage, denial, exhaustion of benefits, late submission, or non-payment, you are responsible for the full amount, except where the practice's contract with the insurance carrier prohibits collecting from you (a "hold harmless" provision).
Fees are disclosed before service is rendered. Published rates are available on request, and a Good Faith Estimate is provided for any planned service or course of care under the federal No Surprises Act.
Payment Methods, Timing, and Card on File
Payment is due at the time of service unless other written arrangements are in place. Sustainable Alignment accepts cash, check, credit and debit cards, and HSA / FSA cards.
Card on file required. A valid credit or debit card on file is required to schedule appointments. By signing this document, you authorize Sustainable Alignment to charge this card for:
- Services rendered at the time of visit if other payment is not provided
- Outstanding balances on your account
- Missed appointment or late-cancellation fees per the practice Cancellation Policy (acknowledged separately at booking)
- Approved program or package payment plan installments per the terms of those agreements
HSA / FSA cards. HSA and FSA funds cannot be used to pay missed appointment or late-cancellation fees. If the card you provide on file is an HSA or FSA card, you are responsible for providing an alternative payment method, or for paying any such fee directly via cash, check, or non-HSA / FSA card upon notification.
If your card is declined, you remain responsible for the balance and any returned payment fee that may apply.
Self-Pay Patients
Self-pay patients pay published rates at the time of service. No insurance claims are filed on the patient's behalf.
ChiroHealthUSA (CHUSA)
ChiroHealthUSA is a voluntary discount medical program that makes chiropractic care more affordable. For $49 per year per household, you get access to reduced rates on every visit, with no claims to file, no authorizations, and no visit limits.
Simple, predictable pricing. Most members find it pays for itself in a single visit.
Sustainable Alignment is a participating CHUSA provider (clinic ID 5590). Rates apply while membership is active. Membership is purchased directly through CHUSA with a 30-day cancellation window from enrollment.
Blue Cross Blue Shield and Affiliated Network Patients
Sustainable Alignment is contracted in-network with Regence BCBS through June 15, 2027. This contract extends to patients with other Blue Cross Blue Shield plans through network reciprocity (BlueCard) and to certain affiliated administrators including HMA (Healthcare Management Administrators).
Covered chiropractic services are billed per the in-network agreement. Non-covered services (including but not limited to nutrition counseling, functional medicine consultation, Align & Ascend program components, and other services outside the chiropractic benefit) are self-pay regardless of insurance status.
Patient cost-share (deductibles, coinsurance, copays) is the patient's financial responsibility and is due at the time of service. Patient remains responsible for any amounts the carrier does not pay, except where the in-network contract prohibits collection from the patient.
After June 16, 2027, Sustainable Alignment will be out-of-network with Regence BCBS and the affiliated networks. Patients can transition to self-pay at the practice's published rates. A new Financial Responsibility & Payment Policy acknowledgment will be requested from active BCBS and affiliated network patients before or shortly after this transition.
No Insurance Claim Negotiation
Sustainable Alignment does not negotiate, appeal, or otherwise advocate with insurance carriers regarding coverage decisions, denials, or reimbursement amounts on the patient's behalf. The patient is responsible for understanding their own benefits, network status, and reimbursement processes.
This applies to all payer relationships, including the Regence BCBS in-network contract and affiliated networks during the contract period.
Motor Vehicle Accident Cases
Acceptance of MVA cases is at the practice's discretion. Patients with active MVA claims may be referred to another provider for care under their claim.
When accepted, MVA cases are handled per the active claim arrangement at the time of intake. The patient remains financially responsible for any balance not paid by the auto insurance carrier or third-party payer.
Medicare Beneficiaries
Sustainable Alignment is enrolled in Medicare as a non-participating provider. Medicare-covered services are limited and are addressed in detail in the separate Medicare Coverage Acknowledgment, which covers coverage scope, non-participating billing mechanics, and Medicare Advantage considerations.
Programs, Packages, and Pre-Paid Care
Programs (including but not limited to Align & Ascend) and pre-paid care packages are separate from per-visit billing.
Program and package fees are not billed through any insurance plan, including Regence BCBS and affiliated networks during the contract period. Specific terms (refund policy, payment plan structure, scope of care included, completion timeline, arbitration and governing law) are documented in each program's enrollment agreement and are signed separately at the time of program enrollment.
Between-Visit Clinical Time
Clinical work performed outside scheduled visits, including chart review, lab interpretation, written care recommendations, and extended communication that requires clinical judgment, is billable at the published consultation rate per the practice Patient Communication Policy. Brief logistical or administrative communication is not billed.
The Patient Communication Policy is provided separately.
Past Due Balances and Returned Payments
Outstanding balances must be brought current before scheduling additional non-emergency care.
Returned check or declined card transactions may incur a fee of $30. Accounts more than 90 days past due may be referred to a third-party collections agency.
Material Changes to This Policy
This policy may be updated periodically. Material changes (significant changes in fee structure, payer status, or program terms) will require a new signed acknowledgment before continuing care. Routine fee adjustments do not require re-acknowledgment.