Mirror Health & Wellness Financial Policy

Download printable version: Financial Policy | Mirror Health & Wellness.pdf

Effective Date: April 10, 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 a self-pay or uninsured patient, or if you do not wish to use insurance, 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.

In accordance with federal law, a copy of your GFE will be provided to you and securely maintained in your patient record for at least six (6) years.

2.3 Accepted Payment Methods

  • Credit cards, debit cards, and 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 FSA or HSA funds to pay for some or all of your membership fee. Please consult your plan administrator to confirm eligibility.

Certain services included in our membership programs may be eligible for reimbursement through Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA). Patients are responsible for determining their eligibility and should consult their plan administrator. Itemized statements are available upon request.

2.5 Declined Payment Fees

Failed or declined transactions are subject to a $25 administrative fee. After 2 failed attempts, services may be paused until the account is brought current.

III. Membership-Based Care Model

3.1 Required for Ongoing Care

Ongoing care requires enrollment in a membership program. These provide continuous support, coordination, access to physician communication, and services that insurance doesn’t cover. Membership allows us to offer longer visits, personalized care, and a proactive approach to your health.

3.2 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.

3.3 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.

 

3.4 Membership Billing & Cancellation

  • Memberships auto-renew and are billed monthly, unless prepaid in full for a set term.

  • Requests for membership cancellation must be made in writing or submitted electronically.

  • Upon completion of the minimum commitment period, the provider will assess your ongoing care needs and may recommend continued membership if appropriate.

  • If you choose to cancel after completing the minimum commitment, you will be charged for the full current month and retain access until the end of that billing cycle.

  • Prepaid membership fees are non-refundable.

  • If you cancel before completing a prepaid term, no refund will be issued; however, under exceptional circumstances, a credit or pause may be considered at the practice’s discretion.

  • If you cancel before fulfilling a minimum-term membership commitment, an early termination fee of $100 may apply, as outlined in your membership agreement.

  • No prorated refunds are given for unused time.

  • A one-time freeze of up to 30 days may be requested per program cycle. During this time, access to services is paused, and billing will resume automatically unless otherwise arranged in writing.

3.5 Membership Payment Terms

  • Payment is due monthly or in advance, depending on your plan

  • Missed payments will pause access to services

  • Unpaid balances may be sent to collections after [3 notices over 60 days]

  • Refunds are not issued for partial use of services once a billing cycle has begun.

IV. Insurance Billing and Network Status

4.1 Current Insurance Status

At this time, Mirror Health Specialists is not contracted with any insurance networks. We are actively in the process of credentialing with top PPO insurance carriers.

Until credentialing is complete, all services will be billed under our self-pay rates.  Patients may request a superbill for possible out-of-network reimbursement through their insurer. We do not guarantee reimbursement.

4.2 Medicare

We welcome Medicare patients at Mirror Health & Wellness. However, please note that we are NOT currently enrolled as Medicare providers. We are in the process of credentialing with Medicare, and until that is complete, we are unable to bill Medicare directly for any services.

If Medicare is your primary health insurer:

  • You are required to maintain your Medicare coverage.

  • Any services received at Mirror Health & Wellness will be billed at our usual and customary self-pay rates.

  • These services will not be reimbursed by Medicare until our credentialing is complete.

  • You will continue to use your Medicare coverage for:

    • Visits with other in-network medical specialists

    • Hospital services

    • Lab work and diagnostic imaging

    • Prescription medications filled at your pharmacy

Our membership and concierge fees cover services not reimbursed by Medicare, such as extended visits, direct physician access, lifestyle and nutrition counseling, and proactive health monitoring. These benefits are provided outside of traditional Medicare billing and are considered optional, direct-pay services.

We encourage you to speak with us if you have questions about how our care model aligns with your Medicare coverage.

4.3 What Insurance May Cover

Although our services require direct payment, you may still use your insurance for:

  • Laboratory tests (when processed through an in-network lab like Quest or LabCorp)

  • Prescriptions (when filled at your preferred pharmacy)

We are unable to verify or guarantee out-of-network reimbursement. It is the patient’s responsibility to confirm coverage with their insurance provider in advance.

V. Accountability for Payments, Appointments, and Continued Care

5.1 No-Show & Cancellation Fee

Appointments canceled less than 24 hours in advance or missed entirely will be charged a $50 no-show fee. This fee is not billable to insurance.

5.2 Late Payment Fees

If a balance remains unpaid 30 days after the due date, a $15 late fee will be applied monthly until paid.

5.3 Collections

Accounts 60+ days overdue with no response after 3 contact attempts (email, phone, and written notice) may be referred to a collections agency. This may apply to:

  • Missed membership payments

  • Self-pay service fees

  • Rejected or unpaid insurance claims where the patient is responsible

5.4 Dismissal from Practice

We may dismiss patients from care for:

  • Repeated non-payment

  • Abusive behavior

  • Misuse of financial assistance programs

  • Non-compliance with policies

VI. Financial Assistance & Discounted Options

6.1 Prepayment Discounts

Self-Pay or uninsured patients who choose to pay for the full duration of their membership at the time of enrollment may be eligible for a 5–10% discount. This discount applies only to services that are not reimbursable by insurance and is offered as a courtesy to support financial planning and accessibility.

Please note: Prepayment discounts cannot be combined with other offers or applied retroactively.

6.2 Financial Assistance & Charity Care

We allocate a portion of membership proceeds to help patients experiencing financial hardship. Assistance is distributed on a case-by-case basis, subject to:

  • Household income

  • Sudden loss of income or insurance

  • Medical expenses exceeding 10% of gross household income

Submit a Financial Assistance Request Form and documentation to be considered. Approved patients may receive:

  • Modified payment options

  • Reduced membership fees

  • Access to a one-time consultation

VII. Insurance Responsibilities

If and when Mirror Health Specialists is credentialed with your insurance:

  • Copays, deductibles, and coinsurance are due at the time of service

  • Your insurance coverage is a contract between you and your insurer—you are responsible for understanding your benefits

  • We will submit claims when applicable, but any denied claims or balances not paid by insurance remain your responsibility.

VIII. Disputes and Dissatisfaction

8.1 Billing Disputes

You may dispute a charge by submitting a written request within 30 days of receiving your invoice. Our team will respond in writing within 10 business days. We strive to resolve all issues quickly and fairly.

8.2 Patient Dismissal

Repeated non-payment, abuse of the financial assistance program, or hostile communication related to financial matters may result in dismissal from the practice.

All patient dismissals will be conducted in accordance with applicable laws and ethical obligations, including offering appropriate notice and continuity of care.

IX. Consent and Acknowledgment

Patients are required to acknowledge this Financial Policy as part of their intake documents. This Financial Policy is part of your full Patient Intake Agreement, which includes our Notice of Privacy Practices (NPP). This policy is also made available on our website and by request.

By acknowledging this policy, you consent to receive billing notifications and updates via your preferred contact method, including SMS and email, where permitted.

Enrollment in a membership program requires signing a separate Membership Agreement, which outlines terms specific to that program.