Neuroplasticity – Telemedicine Series

How To Register

A. I am primarily insured by Regence, Premera, LifeWise, or another BlueCross BlueShield plan AND I have confirmed that the Village Medicine Provider(s) leading the series is/are considered In-Network for my plan. We will bill your insurance for each appointment with the codes: 99215 + (99417 x 3-5).

• Copays will be charged at the time of service for each appointment
• Deductible and coinsurance balances will be due upon notice.
• We urge and encourage you to verify your coverage and avoid a surprise bill!

>>>OR<<<

B. I am primarily insured by a plan that considers our Village Medicine Provider(s) Out-of-Network, or I am uninsured, or I am choosing to pay out-of-network for this series. Payment will be collected at the time of service for each treatment, or some treatments can be purchased up front at a discounted price:

Commitment to Appointment Series 

• The group medicine series requires attendance of every appointment in the series for maximal education and physiological benefit.
• If I miss an appointment in the series, I understand that I will incur the $100 cancellation fee per missed appointment.
• The 48-hour cancellation policy applies to the entire series, not per appointment.
• If I cancel the series outside of the 48hr cancellation policy, I will incur the $100 missed appointment fee for each appointment in the series.
• For example, if class begins on Monday, you need to cancel the class on Thursday since the policy applies to 2 business days.

Space is limited so if you are unable to attend a class, please understand that a $100 cancellation fee will be charged to your card on file (and is not billable to or reimbursable by insurance).