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

Patient Forms

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. At the conclusion of each session you will receive a claim form (Super Bill) that contains the appropriate documentation to file with your insurance. 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 Policy

  1. Because your appointment time has been reserved for you, you will be charged for cancellations with less than 24 hours (one business day) notice.
  2. Charges for missed appointments are not covered by your insurance and must be paid prior to any further appointments.

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.

Financial/Billing Policy

The staff at Lee Side Wellness, LLC (LSW) are committed to providing caring and professional mental health and addiction care to all of our patients. As part of the delivery of services, we have established a financial policy that provides payment policies and options 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.

As a service to you, LSW will 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.

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. Insurance deductibles, co-payments and other payment plans are due at the time of service.

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

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