Lee Side Wellness, LLC
7577 Central Parke Blvd • Suite 113 • Mason, OH 45040
74 Remick Blvd • Springboro, OH 45066
Phone: 513-204-1910 • Fax: 513-204-0049

Lee Side Wellness, LLC

Patient Center

Financial/Billing Policy

The staff at Lee Side Wellness, LLC (LSW) are committed to providing caring and professional mental health care to all of our patients. As part of the delivery of services, we have established a financial policy that provides payment policies and option to all patients. Your insurance policy, if any, is a contract between you and the insurance company; we are not part of the contract with you and your insurance company. 

LSW will bill your insurance or provide you with a statement and claim form for you to submit to other third-party payers but cannot guarantee such benefits or the amounts covered. In some cases, insurance companies or other third-party payers may consider certain services as not reasonable or necessary or may determine that services are not covered. Patients are responsible for payments regardless of any insurance company’s determination of usual and customary rates. LSW will assure that a visit is billed properly but cannot guarantee payment by insurance.  

The Person Responsible for Payment will be financially responsible for payment of such services. The Person Responsible for Payment is financially responsible for paying funds whether they are reimbursable by insurance companies or third-party payers. 

Effective January 1, 2019: 

Insurance deductibles, co-payments and other payment plans are due at the time of service. This includes the full fee of the visit/service provided at your scheduled appointment. LSW will bill the patient at the beginning of the visit for the allowed amount for their specific insurance. Once the patients' deductible is met for the year their co-insurance will be charged until all patient out of pocket expenses have been paid. Once the patient has reached his or her maximum out of pocket, the insurance company should cover their claims at the percentage specified in the patient’s insurance contract. If the insurance reimburses LSW for a service that the patient has already paid for, the patient will be reimbursed for the service. It is at the provider’s discretion to continue clinical services if a patient has outstanding charges. 

Payment methods include check, cash, or the following charge cards: Visa, Amex, MasterCard, Discover and HSA cards. 

Questions regarding the financial policies can be answered by the Office Manager.

Insurance Information

Lee Side Wellness is currently contracted with many insurance companies but not all.  In the interim, if your insurance company does provide out-of-network benefits, you may elect to file your own claims for reimbursement. These claims will be paid directly to you. We recommend that you contact your insurance company directly for specific information regarding your out-of-network coverage for mental health services. The staff of Lee Side Wellness is happy to discuss service fees at the time your initial appointment is made, addressing any questions or concerns prior to your first session.

  1. Patients are responsible for being aware of current insurance coverage. This includes the details of:
    • Out of network benefits
    • Deductible and/or "out-of-pocket"
    • Need for pre-certification
    • Current coverage and co-payment
    • Maximum annual visits
    • Current visits remaining
    • Any changes in coverage
  2. If you have exceeded your benefits covered, you are responsible for the full payment for any uncovered sessions.
  3. Your mental health coverage may be "carved out" to other managed care companies. We are considered out-of-network with those companies.
  4. Please note that your insurance may place limits on the number of visits allowed per calendar year. This may not be sufficient to cover the clinically appropriate level of care determined by your provider.

Office Policies

Appointment Cancellation/No Show Policy

Effective January 1, 2019;

A late cancellation will be charged if the patient fails to give at least 24 hour notice prior to cancelling their  appointment. The first time will be $25.00, any after the initial late cancel will be $115.00 and possible dismissal from the practice.  

A no show fee will be chaged if the patient fails to show for their appointment. The first time will be $25.00, any after the initial no show will be $115.00 and possible dismissal from the practice.  

LSW requires a credit card on file for late cancellations/no shows. If you late cancel or no show your card will be charged.  


Policy Regarding Charges for Paperwork

Effective January 1, 2019;

 LSW will charge a fee for completing paperwork requested by patients. I understand the following: 

  1. One or two page forms that are uncomplicated, can be completed in their entirety during the course of a standard appointment, and are brought to the appointment, will be completed free of charge. Examples include school Medication Administration Forms or camp/sports forms.  

  1. Forms that are not brought to the appointment itself, or are complicated forms requiring additional time from the provider and/or office staff, are charged at the following rates: 

  1. Simple (school/camp forms, letters for court/school/work etc) $25 

  1. Complicated (FMLA, STD paperwork, etc) $50 

  1. Forms will be completed within five (5) business days and returned to you by email, unless otherwise noted. Your credit card will not be charged until the paperwork is completed by LSW staff and returned to you.  

  1. Any questions regarding whether paperwork is considered simple or complicated may be referred to your provider or the Office Manager. 

  1. Any exceptions to this policy are at the discretion of the provider and should be discussed directly with your provider.  

Prescription Refill Policy

  1. To ensure quality of care, regular follow up with routine office visits is necessary for prescriptions to be provided.
  2. If 2 or more scheduled office visits have been missed, or the time since last visit exceeds 90 days, the provider must be seen before any prescriptions are written.
  3. Please inform your provider about needed refills at least 3 business days before your medication runs out. Set aside an emergency reserve of 3 to 5 days of each prescription.