Mirror Health & Wellness Financial Policy
Effective Date: June 3, 2025
Applies to: All services provided by Mirror Health Specialists and Mirror Health & Wellness, LLC, collectively referred to as “Mirror Health & Wellness.”
I. Financial Policy Overview
1.1 Our Payment Philosophy
At Mirror Health & Wellness, we believe transparency builds trust. Our concierge-style care model is designed to provide you with high-quality, physician-led care that’s accessible, flexible, and proactive. This Financial Policy outlines your responsibilities and our policies around payment, insurance, memberships, and billing so there’s no confusion.
Our goal is to make your health journey—and your financial experience—as seamless as possible.
1.2 Required Information
Patients must provide and update the following:
Valid government-issued ID
Current insurance information (if applicable)
Contact information and date of birth
Preferred payment method
1.3 Billing Inquiries and Contact Information
If you have any questions about your bill, insurance claims, payment options, or this Financial Policy, please reach out to us:
Email: support@mymirrorhealth.com
Phone: +1 (657) 708-0074
Mailing Address:
Mirror Health & Wellness
5750 Downey Ave., Suite 303
Lakewood, CA 90712
We’re here to help ensure you have a clear and supportive financial experience.
II. Fee Disclosure and Payment Methods
2.1 Fee Transparency
Patients will be provided with a current fee schedule upon request. Our standard rates apply to both self-pay and out-of-network billing scenarios. Any changes to our pricing will be communicated in writing at least 30 days in advance.
2.2 Good Faith Estimates for Self-Pay Patients
If you are uninsured, receiving non-covered services, or receiving services from us as an out-of-network provider, you are entitled to a Good Faith Estimate (GFE) under the No Surprises Act.
The GFE will outline the expected cost of your care.
You may request a GFE prior to scheduling or at any time.
A written GFE will be provided upon scheduling if your services are expected to exceed $400.
Submitting a request does not obligate you to receive services.
A copy of your GFE will be securely maintained in your patient record via our secure EHR portal for at least six (6) years.
Please note: If you are covered by a health insurance plan for which Mirror Health Specialists is in-network, we are generally required to submit claims to your insurer for covered services, and you are responsible for applicable copays, deductibles, and coinsurance. We cannot apply GFE pricing or self-pay arrangements to covered services in those circumstances.
2.3 Accepted Payment Methods
Credit cards
Debit cards
HSA/FSA cards
Payments are processed via our secure platform. We do not accept checks, cash, or third-party payment apps (e.g., Zelle). Patients are required to keep a valid card on file for all services.
2.4 HSA/FSA Eligibility
You may be able to use funds from your Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to pay for some or all of your membership fee, as well as for insurance copayments, where permitted. Please consult your plan administrator or tax advisor to confirm which services and fees are eligible under your plan. Itemized statements are available upon request.
2.5 Declined Payment Fees
Failed or declined transactions are subject to a $25 administrative fee. If a payment attempt fails, we will notify you and provide an opportunity to update your payment method. If two attempts are unsuccessful, we may apply the administrative fee and pause access to non-covered concierge services until your account is brought current. This does not affect your ability to receive insurance-covered medical care if you are an in-network patient.
III. Membership-Based Care Model
3.1 Access to Membership Services
Membership is required to access our concierge offerings and ongoing wellness support services, such as extended visit time, wellness planning, care coordination, lifestyle coaching, and non-covered communication access. These services are not billable to insurance.
Membership is not required for medically necessary care that is covered by your contracted insurance plan.
3.2 Concierge Services
The following non-covered concierge services are included with your membership and are not billable to insurance:
Direct messaging access to the physician for non-urgent matters
Priority appointment scheduling
Extended, personalized appointment times
Customized lifestyle, nutrition, and wellness planning
Personalized meal planning based on medical conditions
Behavioral coaching and goal tracking
Supplement and medication management assistance
Wellness tracking and remote monitoring support
Quarterly wellness summary reports (available for Annual Memberships)
Invitations to exclusive webinars and educational programs
Personalized care coordination with external specialists
Timely prior authorizations
These concierge services are considered non-covered under Medicare and commercial insurance plans and are provided solely on a self-pay basis.
Please note: Medical appointments, consultations, and professional services are billed separately and are not included in the Membership Fee unless otherwise stated in your Membership Agreement.
3.3 One-Time Consultations
We offer one-time consultations for patients seeking guidance before committing. These do not include follow-up care, prescriptions, or long-term management unless you join a membership.
3.4 Membership Tiers & Terms
We offer flexible membership options:
Month-to-month plan (2-month minimum commitment)
3-month commitment (reduced rate)
6-month commitment (further discounted)
We recommend a minimum of 3 months to see meaningful clinical progress.
3.5 Membership Payment Terms
Payment for membership is due monthly or in advance, depending on your selected plan. If payment is not received, access to non-covered concierge services may be paused until the account is brought current. Unpaid balances may be sent to collections after three contact notices over 60 days. Refunds are not issued for partial use of services once a billing cycle has begun. These terms apply only to membership services and do not affect your ability to access insurance-covered medical care if you are an in-network patient.
3.6 Membership Billing & Cancellation
Memberships auto-renew and are billed monthly unless prepaid in full. Cancellation must be submitted in writing or electronically. After fulfilling the minimum commitment, you may cancel your membership, with billing ending at the close of the current month. Prepaid memberships are non-refundable; however, exceptions may be considered in cases of documented financial hardship. If you cancel before completing your committed term, a $100 early termination fee may apply. A one-time 30-day freeze may be requested per term; services are paused during this time, and billing resumes unless otherwise arranged. Cancellation of membership does not affect your eligibility to receive covered medical services if you are insured under a plan for which we are in-network.
IV. Insurance Billing and Network Status
4.1 Current Insurance Status
Mirror Health Specialists is currently contracted with select PPO insurance plans, including Aetna, Anthem Blue Cross, and UnitedHealthcare. We are not contracted with HMO plans or Medi-Cal. We will verify your eligibility and benefits prior to service when possible, but you remain responsible for understanding your plan and coverage.
If you have a PPO plan for which we are out-of-network and your plan includes out-of-network benefits, you may still receive services and request a superbill for possible reimbursement. We do not guarantee any reimbursement for out-of-network care. Medicare is addressed separately in the following section.
4.2 Medicare
Mirror Health Specialists is enrolled with Medicare and accepts Medicare for eligible services. Our concierge membership offerings include services that fall outside of traditional Medicare billing (e.g., extended visits, wellness coaching, nutrition planning). These services are considered non-covered and are billed separately, with payment due directly from the patient.
Medicare patients are responsible for their applicable deductibles, coinsurance, and any services not covered under Medicare. While we will submit claims for eligible services, Medicare patients are ultimately responsible for understanding their coverage and benefits. We cannot guarantee Medicare reimbursement for any specific service or charge outside of what Medicare determines is covered.
4.3 Use of Insurance for Ancillary Services
You may continue to use your insurance for certain ancillary services, including:
Laboratory tests (e.g., Quest, LabCorp)
Prescriptions filled at your preferred pharmacy
Hospital visits and care provided by specialists
We will coordinate with your preferred labs and pharmacies where possible. These ancillary services are billed directly by the respective provider, not Mirror Health & Wellness. You are responsible for verifying coverage with your insurer. This section is included for informational purposes and does not override your responsibility to understand what services your insurance plan does or does not cover.
V. Accountability for Payments, Appointments, and Continued Care
5.1 No-Show & Cancellation Fee
Appointments canceled less than 24 hours in advance or missed will be charged a $50 no-show fee. This is not billable to insurance.
5.2 Late Payment Fees
Balances unpaid after 30 days will accrue a $15 late fee monthly. Late fees apply only to balances owed directly by the patient that are past due and not under insurance review or appeal.
5.3 Collections
Accounts 60+ days overdue with no response after 3 contact attempts may be referred to a third-party collections agency for balances that are patient-responsible and not pending insurance resolution or appeal. We comply with applicable laws and industry standards, including those limiting credit reporting of medical debt.
5.4 Dismissal from Practice
We may dismiss patients for repeated non-payment, abusive behavior, or non-compliance with financial policies. Dismissals will follow applicable legal and ethical guidelines, including 30 days' notice with referral assistance if medically appropriate.
VI. Financial Assistance & Discounted Options
6.1 Prepayment Discounts
Self-pay patients paying in full at enrollment may receive a 5–10% discount. This applies only to services not reimbursable by insurance. Discount must be applied at the time of enrollment and cannot be combined with other offers.
6.2 Financial Assistance
Financial assistance is available on a case-by-case basis for non-covered services such as membership fees. It does not apply to insurance copays, deductibles, or coinsurance. Please contact our office to inquire about financial assistance and provide any relevant documentation.
VII. Insurance Responsibilities
If Mirror Health Specialists is contracted with your insurance plan, copays, deductibles, and coinsurance for covered services are due at the time of service. Your insurance is a contract between you and your insurer, and you are responsible for understanding your plan’s terms and limitations. We will submit claims for covered services when applicable, but any remaining balances not paid by your insurance remain your responsibility.
VIII. Disputes and Dissatisfaction
8.1 Billing Disputes
If you have a billing concern or believe there is an error, please contact us. To formally dispute a charge, you must submit a written request within 30 days of receiving your invoice. We will respond within 10 business days.
8.2 Patient Dismissal
Repeat non-payment, abuse of assistance programs, or hostile conduct related to finances may result in dismissal, with proper notice and care transition support.
IX. Consent and Acknowledgment
Patients must acknowledge this Financial Policy during intake. It forms part of the full Patient Intake Agreement and is also available on our website.
By acknowledging this policy, you consent to receive billing-related updates via SMS and email, where permitted. You may change your communication preferences at any time by contacting our office.
Enrollment in a membership program requires a separate Membership Agreement, which outlines non-covered services provided outside of insurance.
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