Financial Policy

Effective Date: January 1, 2026

1. Overview

LoDo Pain, LLC operates as a self-pay specialty chronic pain clinic.

This Financial Policy explains payment expectations, billing procedures, and related administrative policies. By scheduling or receiving services, you agree to the terms outlined below.

2. Self-Pay Model

LoDo Pain operates on a direct-care, self-pay basis.

Clinical services are not billed to commercial insurance carriers.

We do not participate in-network with insurance plans.

Payment is due at or before the time of service unless otherwise specified in writing.

This model is not insurance and is not a prepaid health plan.

Payment of fees does not guarantee any specific treatment, medication, prescribing decision, or continuation of care.

Insurance may be used separately for prescriptions, laboratory services, imaging, or other third-party services not operated by LoDo Pain.

3. Medicare & Medicaid (AHCCCS)

LoDo Pain does not provide services to individuals enrolled in Medicaid, including the Arizona Health Care Cost Containment System (AHCCCS).

Certain LoDo Pain providers have formally opted out of Medicare and may enter into private contracts with Medicare beneficiaries in accordance with federal law.

If you are enrolled in Medicare and choose to receive services from an opted-out provider:

Services will be provided under a written private contract as required by federal regulations.
Neither the provider nor the patient may submit claims to Medicare for reimbursement.
Medicare will not reimburse for services provided under the private contract.
The patient agrees to be fully responsible for payment of all charges.

If you are enrolled in Medicare or Medicaid, you must notify our office prior to scheduling services.

4. Payment Terms

A valid payment method must be maintained on file.

Fees may be collected at the time of scheduling or at the time of service.
Failure to maintain a valid payment method may result in cancellation or rescheduling of appointments.
Outstanding balances must be resolved prior to future scheduling.

5. Intake Screening & Initial Evaluation / Administrative Setup

Prospective new patients must complete an intake screening process before being scheduled for an initial consultation.

An Intake Screening Fee is required before medical records are reviewed and the intake screening process begins. This fee covers administrative and clinical time required to:

Collect and review prior medical records
Conduct preliminary intake screening
Determine whether the patient may be an appropriate candidate for care within the LoDo Pain program

The Intake Screening Fee is non-refundable regardless of approval outcome.

Payment of the Intake Screening Fee does not guarantee approval for care.

If a patient is approved following the screening process, an Administrative Setup & Initial Consultation Fee is required prior to scheduling the initial appointment.

This fee covers onboarding, intake processing, administrative setup, and the initial provider consultation associated with establishing care at LoDo Pain.

Completion of the intake screening process or payment of any fees does not guarantee acceptance into the practice, prescription of medications, or continuation of care.

6. Ongoing Care Access Plan

Certain patients requiring ongoing medication management may be enrolled in a Care Access Plan.

Care Access Plan fees:

Are billed automatically on the 1st of each month
May be prorated for the initial month
Are non-refundable once the billing period has begun
Provide scheduled follow-up access and administrative coordination

Enrollment in the Care Access Plan:

Does not guarantee prescribing of any medication
Does not guarantee continuation of any specific treatment
Does not alter clinical decision-making

Written notice is required prior to the next billing cycle to discontinue enrollment.

7. Enhanced Monitoring Fee

Certain treatment plans may require enhanced clinical monitoring to support safe chronic pain management.

Monitoring requirements are determined by the prescribing provider based on clinical risk factors, medication regimens, and clinic safety protocols.

When enhanced monitoring is required, an Enhanced Monitoring Fee may apply.

Enhanced monitoring may involve additional clinical and administrative services such as:

Increased urine drug screening
Additional chart review
Pharmacy coordination
Additional clinical oversight related to controlled medication management

Implementation of enhanced monitoring does not imply wrongdoing or noncompliance and is intended to support safe, responsible care.

8. AutoPay & Recurring Payments

Patients enrolled in AutoPay authorize recurring charges to the payment method on file for applicable Care Access Plan fees and authorized charges.

If a scheduled AutoPay transaction:

Fails
Is declined
Is reversed
Is disputed
Or is otherwise not successfully processed

The AutoPay discount (if applicable) will be removed for that billing period, and the standard rate will apply.

The discounted rate resumes once AutoPay is restored and payments are current.

9. Nonpayment & Administrative Action

Failure to maintain current payment status may result in:

Appointment cancellation
Suspension of scheduling
Administrative discharge from the practice, subject to clinical review and patient safety considerations

Administrative discharge for nonpayment does not obligate continuation of treatment beyond applicable legal or ethical requirements.

10. Refund Policy

Fees for:

Completed appointments
Onboarding/setup processing
Care Access Plan billing periods

Are non-refundable once services have been rendered or the billing period has begun.

Refunds are issued only in cases of verified administrative error or duplicate billing.

Approved refunds are processed to the original payment method within 7–10 business days.

Where permitted by law, a processing adjustment of up to 3% may be deducted to offset non-recoverable merchant transaction fees.

11. Missed Appointments & Cancellations

Appointments must be canceled at least one (1) business day in advance.

Missed appointments or late cancellations may result in:

A missed appointment fee
Forfeiture of prepaid visit fees
Rescheduling restrictions

Repeated missed appointments may result in administrative review of continued scheduling eligibility.

12. Third-Party Services

Pharmacy services, laboratory testing, imaging, and other ancillary services are not operated by LoDo Pain.

Patients are responsible for charges associated with third-party providers.

Coverage for such services is determined by the patient’s individual insurance plan.

13. Billing Inquiries

If you believe a billing error has occurred, you must notify us in writing via email at info@lodopain.com within 30 days of the charge.

We will review and respond promptly.

14. Important Notice

Payment of fees does not guarantee:

Evaluation for controlled substances
Prescription of any medication
Dose escalation
Continuation of therapy
Enrollment eligibility in any structured care plan

All clinical decisions are made by licensed healthcare providers based on medical judgment, safety standards, and applicable law.