Rates and Payment

Unless other arrangements have been made, the rates above apply.

Dr. Ingram does not accept Medicare or Medi-Cal as forms of payment (Non-Participating Provider).

For patients with PPO Insurance Plans: Dr. Ingram is considered an “Out-of-Network” Provider. Some insurance companies will pay for services from “Out-of-Network” Providers, but there is no guarantee that your insurance company will pay for services. You are responsible for paying the total amount billed, regardless of whether your insurance company pays. Furthermore, Dr. Ingram is not responsible for any communication with insurance companies. This includes, but is not limited to, generating insurance claims (except for specific insurance companies such as Cigna PPO, Aetna PPO, Blue Cross Blue Shield PPO, Anthem PPO Plans, and United Healthcare PPO Plans), disputing reimbursements, or completing prior authorization forms for medications, laboratory studies, or other diagnostic studies recommended by Dr. Ingram. You will be able to generate an insurance claim for yourself through Luminello, Inc., the electronic medical record (EMR) system used by Dr. Ingram. If needed, Luminello has a user- guide to help you generate an insurance claim that you can submit to your insurance company.

There is no guarantee that your insurance company will reimburse you for the services provided by Dr. Ingram. You will be considered a self-pay patient during the entire course of treatment with Dr. Ingram unless Dr. Ingram decides to accept your insurance plan in the future. Payment is due no later than 48 hours after your scheduled appointment. Failure to pay for services on time will result in an additional fee of $50.00 and could result in termination of care.

The rates (prices) listed above will not change for the first 12 months of treatment, which begins on the day of your initial consultation visit and ends exactly 12 months after the day of your initial consultation visit. After the initial 12 months of treatment, rates (prices) for services may increase by no more than 10% each year. Rates (prices) for services will never increase above 20% of the prices listed above. You always have the option of discontinuing treatment with Dr. Ingram at any time and he will offer you referrals upon request.

Accepted methods of payment:*

• Cash
• Personal Check or Money Order
• Venmo
• Zelle
• Credit Card/Debit Card
• NOTE: You can generate your own insurance claim to submit to your insurance company for reimbursement by going to “Billing” and “Create Statement”. If needed, I am happy to do this for you and send to you as a PDF.

*Payment must be received within 48 hours after the time of your appointment. If you choose to discontinue care before treatment is complete, your refund will be determined upon review of your case. If you have questions about your treatment plan or the choice of payment options, please do not hesitate to ask. We are here to help you get the healthcare you want or need.

What are all the potential Fees I could incur during my treatment with Dr. Ingram?

1. Cancellation Fee: Appointment cancellations made within 48 hours of your scheduled appointment are subject to a $50 Cancellation Fee.
2. Late Payment Fee: Failure to make a payment within 48 hours after your scheduled appointment time will incur a Late Payment Fee of $50. Failure to make a payment within five (5) days after your scheduled appointment will result in your credit card or debit card being charged for the Late Payment Fee plus (+) the price of services rendered.

NOTE: Failure to pay after one week of payment due date may result in termination of care, referral to another physician, and payment may be sent/sold to a third party collections agency.