America’s Health and Wellness is a small, independently owned primary care practice committed to providing high-quality, personalized, and accessible healthcare.
Unlike membership-based or concierge practices, we do not charge membership or subscription fees for access to our providers. To continue providing quality healthcare, however, our practice must receive appropriate payment for the medical services we provide.
Our financial policies are designed to promote fairness, transparency, and financial responsibility while respecting patients’ rights and applicable insurance requirements.
Understanding Insurance & Patient Responsibility
America’s Health and Wellness does not receive payment from insurance companies simply because a patient is enrolled in a particular health plan. Instead, our practice receives reimbursement for individual healthcare services provided.
Depending on the patient’s insurance benefits, payment may come from the insurance company, the patient, or a combination of both. Patient financial responsibility may include:
- Copayments
- Deductibles
- Coinsurance
- Noncovered services, when legally billable to the patient
These amounts are generally determined by the patient’s insurance plan and applicable contractual requirements. Patients are responsible for providing accurate, current insurance information and notifying our office of changes in coverage.
All patient charges remain subject to applicable federal and New Mexico laws, government-program protections, and insurance contracts.
Copayments
A copayment is a fixed amount that an insurance plan may require a patient to pay for certain healthcare services. Copayments are part of the patient’s insurance benefits and are not additional fees imposed by America’s Health and Wellness.
Our agreements with insurance companies may require us to collect applicable patient cost-sharing amounts. Copayments are due at the time of service unless otherwise required by law, prohibited by the patient’s insurance coverage, or addressed through an approved arrangement.
Certain patients, including qualifying Medicaid and Medicare beneficiaries, may be protected from some or all cost-sharing charges. America’s Health and Wellness will not collect copayments or other charges that patients are legally prohibited from being billed.
Deductibles & Coinsurance
Many insurance plans have deductibles that patients must satisfy before their insurance begins paying for certain services. As a result, patients may be responsible for some or all of the insurance-contracted cost of an office visit until their deductible has been met.
America’s Health and Wellness does not establish insurance deductibles or coinsurance requirements. When possible, our office may verify insurance benefits and provide an estimate of the patient’s expected financial responsibility.
Estimated patient responsibility may be collected at the time of service when permitted by applicable law and insurance requirements. These amounts are estimates and may change once the insurance company processes the claim.
After insurance processing:
- Any additional legitimate patient responsibility will be billed.
- Any overpayment will be credited or refunded as appropriate.
- Contractual adjustments will be applied.
- Patients will not be charged amounts prohibited by their insurance coverage or applicable law.
Balance Billing
America’s Health and Wellness follows applicable insurance contracts and federal and New Mexico balance-billing restrictions. When our practice participates with an insurance company, we generally agree to accept the insurer’s contracted allowable amount for covered services.
The patient may still be responsible for applicable copayments, deductibles, or coinsurance within the allowed amount. America’s Health and Wellness does not engage in balance billing prohibited by insurance contracts or applicable law.
Why Payment Matters
America’s Health and Wellness is committed to maintaining an independent primary care practice without requiring membership or concierge fees. Patient payments help support the essential costs of providing healthcare, including:
- Clinicians and support staff
- Medical supplies and equipment
- Vaccines and medications
- Clinical technology and electronic health records
- Facility expenses
- Administrative and operational costs
Providing healthcare requires significant resources, and timely payment helps ensure our practice can continue serving patients. We respectfully ask patients to fulfill their legitimate financial responsibilities and communicate with our office when payment difficulties arise.
Outstanding Balances
Patient balances are due within 30 days of the first billing statement, unless otherwise specified by an approved payment arrangement or applicable insurance requirements. Patients with outstanding balances are encouraged to contact our office promptly.
When a balance remains unpaid after the payment deadline, America’s Health and Wellness may request payment or an approved payment arrangement before scheduling additional nonurgent appointments, when legally and contractually permitted. An unresolved balance may affect the scheduling of future nonurgent services.
However, financial policies will not be applied in a manner that violates applicable insurance requirements, patient protections, or professional obligations concerning continuity of care. Medical necessity, the patient’s clinical circumstances, and applicable legal requirements will be considered before restricting services.
Patients who cannot pay their balances in full are encouraged to contact our office to discuss available payment arrangements.
Payment Arrangements & Financial Hardship
America’s Health and Wellness recognizes that unexpected medical expenses can create financial difficulties. Patients experiencing financial hardship are encouraged to communicate with our office before an account becomes significantly overdue.
Depending on individual circumstances, available options may include:
- An approved installment payment arrangement
- Review of disputed charges or insurance processing errors
- Consideration of financial hardship accommodations
- Information about applicable public insurance or financial assistance programs
Payment arrangements must be approved by the practice and maintained according to their agreed terms. Financial hardship alone does not automatically result in dismissal from the practice.
Any financial accommodation will be administered consistently with applicable insurance contracts, government-program requirements, and federal and New Mexico law.
New Mexico Medical Debt Protections
America’s Health and Wellness complies with the New Mexico Patients’ Debt Collection Protection Act. This law provides important protections for qualifying low-income patients.
Patients whose household income is at or below 200% of the applicable federal poverty guidelines may qualify for protections against medical debt collection actions. Patients may request an indigency determination and information about their rights under New Mexico law.
America’s Health and Wellness will not pursue prohibited collection actions against patients determined to be indigent under applicable law. Our practice will follow applicable requirements concerning financial screening, patient notifications, and medical debt collection.
Patients may request additional information about available protections and financial assistance resources by contacting our office.
Collections
Referring a patient’s account to collections is not our preferred outcome. America’s Health and Wellness would rather work directly with patients to resolve outstanding balances. However, unpaid balances can create significant financial challenges for a small independent medical practice.
When a legitimate balance remains unpaid despite reasonable attempts to resolve it, America’s Health and Wellness may refer an eligible account to an outside collection agency, provided the referral and collection activities are permitted by applicable law.
Before pursuing collection action, the practice will comply with applicable requirements for determining whether a patient qualifies for protection under New Mexico’s Patients’ Debt Collection Protection Act. Accounts belonging to patients protected from collection actions under applicable law will not be referred for prohibited collection activity.
Collection activity will also comply with applicable insurance requirements, patient privacy protections, and federal and state consumer protection laws.
Continued Care & Dismissal From the Practice
America’s Health and Wellness values long-term relationships with patients and considers dismissal from the practice a last resort. Nevertheless, repeated failure or refusal to address legitimate outstanding financial obligations may result in review of the patient-provider relationship.
When legally permissible, continued nonpayment may be considered grounds for termination of the patient-provider relationship after reasonable attempts to resolve the matter. Any decision to terminate a patient-provider relationship will be made in accordance with applicable professional standards, insurance requirements, and federal and New Mexico law.
When termination is appropriate, America’s Health and Wellness will:
- Provide appropriate written advance notice.
- Consider the patient’s ongoing medical needs.
- Address necessary transitional care consistent with applicable professional obligations.
- Facilitate transfer of medical records upon appropriate authorization.
- Provide information to assist with transitioning to another healthcare provider, when appropriate.
Patients will not be abandoned or subjected to termination practices prohibited by applicable law. Financial hardship alone will not automatically result in termination.
Questions or Concerns About a Bill?
We encourage patients to contact our office whenever they have questions about their financial responsibility. Insurance claims can sometimes be processed incorrectly. Coverage may change, deductibles can be confusing, and billing errors occasionally occur.
We would rather address concerns directly than have patients avoid necessary healthcare because of uncertainty about a bill. America’s Health and Wellness is committed to:
- Accurate and transparent billing
- Respecting applicable insurance contracts
- Avoiding prohibited balance billing
- Correcting billing errors
- Respecting patient financial protections
- Treating patients with professionalism, fairness, and compassion
In return, we ask patients to communicate openly with our practice and make reasonable efforts to fulfill their legitimate financial responsibilities.
Have a question about your bill?
We’re glad to help you understand your coverage, review a charge, or set up a payment arrangement. Reach our office and we’ll walk through it with you.
Important Financial Policy Notice
This policy applies only to the extent permitted by applicable federal and New Mexico law, government healthcare program requirements, and the patient’s insurance benefits and provider agreements.
If any provision conflicts with applicable legal or contractual requirements, those requirements will control.
America’s Health and Wellness reserves the right to update this financial policy as necessary to maintain compliance with applicable requirements.
Thank you for choosing America’s Health and Wellness for your healthcare needs.