Thank you for choosing premier allergy & asthma as your healthcare provider.

Please carefully review this financial policy.  As your health care provider, our relationship is with you and not your insurance company.  As a courtesy to our patients, we strive to provide you with an estimate of your financial responsibility as obtained from your insurance company.  Please remember that your insurance plan benefits are a contract between you and your insurance company and, in many cases, your employer.  It is in your best interest to know and understand your benefits.  Please contact your insurance company and/or your employer’s human resource department with your benefits questions. 

Prior to each of your visits, premier allergy & asthma will, as a courtesy, attempt to provide you with an estimated financial responsibility.  This estimate is provided to us by your insurance company.  You are responsible for this estimated cost at the time of service as well as other potential costs related to the services provided, including but not limited to co-pay, deductible, co-insurance, and any other non-covered benefits that may not have been included in the estimate. premier allergy’s inability to provide you with such an estimate does not absolve you of your financial responsibility for the services provided to you.

Patient’s Financial Responsibility

Virtual visits


Cancellation/Rescheduling fees


Patient’s Financial Responsibility

For patients with insurance coverage:

  • If the patient’s estimated financial responsibility is less than $100, payment for the full amount of this estimate is required at the time of service. 
  • If this amount is over $100, payment of 50% of this estimate is required at the time of service. 
  • Please resolve your questions or concerns about your estimated cost with your insurance company in a timely manner.  A reference from our communication with your insurance company is provided in your estimate.  Please use this information when contacting your insurance company.
  • A visit that is cancelled, rescheduled, or results in a no-show due to the patient’s or guarantor’s refusal to pay for services based on this estimate will be subject to our cancellation/rescheduling/no-show policies.
  • You will receive a bill for the remaining balance once your insurance company finalizes all of the charges and payments related to this visit.
  • If the insurance information that you have provided is incorrect or incomplete, you will be responsible for the unpaid charges.
  • Occasionally, your health insurance company may request further information directly from you in order to process claims we have submitted.  We ask that you respond quickly to your health insurance company if such a request is made.  In the event that your health insurance company denies claims based on a delayed or inadequate response from you to them, you and/or your guarantor will be held liable for those denied charges.  

For self-pay patients:

  • 100% of the patient’s financial responsibility is due at the time of service.

Any checks with non-sufficient funds will be released to a collection agency, and a $20 fee will be added to your account.

Payment is due at the time of service and immediately after all claims are finalized by your insurance company.  Failure to make full payment on past-due accounts may result in that account being turned over to a collection agency.  Patients referred to a collection agency may be dismissed from the practice.

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Virtual Visits

For scheduled virtual visits, our policy as outlined in “Patient’s Financial Responsibility” applies to these visits.

For virtual visits that are initiated by the patient such as a telephone call or an e-visit seeking medical advice, clarification on diagnosis or treatment plan, recommendations for other health care services, or other medically related questions, premier allergy will submit charges to your insurance company based on their requirements for these visits.  

Self-pay rate will apply to patients who do not have insurance coverage and to those whose insurance plans do not provide coverage for these virtual visits.

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Insurance companies may require authorization and/or a referral to see our providers.  It is the patient’s responsibility to contact their insurance company and/or primary care provider and facilitate the required authorization/referral for such services with premier allergy.   All non-covered benefits due to improper authorization/referral will become the patient’s responsibility.  If authorization/referral has not been obtained, your appointment may be rescheduled.  The cancellation/rescheduling fee may apply.

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Cancellation/Rescheduling/No-show Fees:

We understand that you may have an unexpected change in your schedule.   Please contact us as soon as possible to cancel or reschedule your appointment(s).   

Should you have an urgent situation that arises within 2 business days of your scheduled appointment, simply give us a call.  We will find a different time on the same day as your existing appointment that better fits your new schedule.  

If you are under the weather or unable to travel to our office as scheduled, please call us, and we will change your appointment to a telehealth or a telephone visit so that you can keep your appointment from the comfort of your home.  

As we all know, traffic in our Denver metro area has increased as our community has grown.  If you are running late, let us know as your safety is our priority.  We will work to fit you in to our schedule on the same day.

To help us continue with providing comprehensive care for you and other patients, an appointment that is cancelled, rescheduled, or results in a “no-show” without 2 business days advanced notice and that is not converted into a telephone visit or telehealth visit will result in a $50 fee for an existing patient appointment and a $150 fee for a new patient appointment.  This fee will apply regardless of whether we receive your confirmation of your financial responsibility estimate and/or portal information.

A visit that is cancelled, rescheduled, or results in a no-show due to the patient’s or guarantor’s refusal to pay the estimated fee will be subject to our cancellation/rescheduling/no-show policies.

Repeated cancellation and/or no-show of your appointments may result in dismissal from the practice.  

Some testing appointments require our team to prepare medications or extracts used for testing prior to your arrival.  You may incur an additional fee or expense if this type of appointment is cancelled, rescheduled, or results in a “no-show” without 24-hours’ notice.

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Our providers carefully review the medical record to individualize forms for each patient.  This ensures accuracy and appropriate continuity of care for our patients, whether it is at your child’s school or your work place.  An office visit is usually required to complete these forms with the most updated information.   

Please provide us with the forms you need.  We do not provide any access to internet, printing, or copying for these forms at our office.

For school forms or camp forms, help us by planning ahead for your upcoming visit.  Bring the forms in with you during your annual evaluation or a follow up visit, and our providers will complete them as part of the visit at no extra charge.  

If your child’s last appointment with us was within the past 6 months and there is no change in his or her health, simply send in the form.   Our providers will review your chart and complete the forms for you for a $5 fee per request.  

An office visit is required to complete FMLA forms.  Fees for other forms or letters will be assessed individually based on their requirements.

Regrettably, we cannot complete forms for patients who have not been seen in the past 12 months.  An office visit will be required in order for us to safely and accurately complete the form(s).

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