If you can afford to purchase a prepayment program, please do so. If you cannot, the Honor Box will always be available for you.
When using the Honor Box, please make the payment as close as you possibly can to the standard fee of $40.00.
Throughout the course of your care, you may switch back and forth between a prepayment program and the Honor Box.
Kindly remember that Hawaiian Pacific Chiropractic is required to pay a general excise tax on everything paid to the Honor Box.
Make payments right after your adjustment by placing the cash amount or check into the Honor Box (the black mailbox) sitting on the front desk. Placing your payment in an envelope is not necessary. If you want to make a payment on your credit card, just ask Dr. Shiraki or one of his assistants to process that charge.
We do not track or record your payments to the Honor Box.
If you wish to file with an insurance company, we can help you with the paperwork, but ultimately the receipt of reimbursement is your responsibility. A patient will not be allowed to use the Honor Box and file a claim at the same time.
We reserve the right to revoke a patient’s Honor Box privileges if it is deemed that he or she is abusing the system.
All patients who use the Honor Box must make a firm commitment to refer friends and family to this clinic. In order to keep this system a true WIN/WIN arrangement, this clinic must always have a steady flow of new patients.
No matter what you pay, no matter how you pay, you will always get our best.
1. You may pay for your chiropractic fees out-of-pocket at the time of service, or use the Honor Box, or file claims with your insurance company. You may switch options but may utilize only one option at a time.
2. The Honor Box exists for those patients who cannot afford chiropractic care otherwise. It is our mission to make chiropractic affordable for all people living on this island. Please do not wrongly utilize and take advantage of the Honor Box system. Pay as close as you possibly can to the $50.00 office visit fee.
3. You will be given a treatment plan on your second visit which will give you a good overview of how long your chiropractic care will take and how often you will need to be seen. Because our fees are all up front, you should have a clear picture as to how much your treatment plan will cost all together. If you need help understanding or computing a good faith estimated amount for your treatment plan, please ask a doctor or a chiropractic assistant. If you are using CMS Medicare Insurance (not Medicare Advantage plans) we are required to have you complete and sign an Advance Beneficiary Notice of Noncoverage (ABN) form in addition to this one.
4. If you are using insurance, your copay is due at the time of service. We will file all your claims for you. If your insurance company reports to us that your yearly deductible has not yet been met, we will ask that you take care of the balance as soon as possible.
5. If your insurance company denies a claim, it will be your responsibility to cover the costs of your care that was not paid in a timely matter. If there is a balance due because of an insurance denial, you may cover your costs with our normal out-of-pocket office visit fees, including our prepayment plans.
6. Very rarely will insurance pay for care beyond your treatment plan. Usually, chiropractic services after your treatment plan will be considered maintenance or wellness care and not covered. Other reasons why your care may be considered not medically necessary are if your visits are spaced out too much, your symptoms are not getting better, or if you repeatedly report having minimal or no symptoms. You will be responsible for paying for your maintenance care fees when not covered by your insurance.
7. At times, an insurance company may consider your chiropractic visits medically unnecessary and therefore deny your claim even before the maximum visits per year are met. For example, your insurance policy may say that you have a maximum of 20 chiropractic visits a year. However, after only 12 visits, they decide that your treatments are no longer medically necessary. If this happens, you will be responsible for paying out-of-pocket for any claims which were denied and for any further care you wish to receive that calendar year. On January 1, your benefits reset and even if your care was considered medically unnecessary or all used up the previous year, you will be eligible to start your insurance claims again.