617 5th Ave S. Edmonds, WA 98020
Concierge and Non-Covered Services Fee
Patient Agreement with North Seattle Natural Medicine
This Agreement ("Agreement") is made between North Seattle Natural Medicine ("Provider") and below signed ("Patient"), effective July 1, 2024 for patients of Drs. Lush and Sinclair, and January 1, 2025 for patients of Dr. Tausend.
Provider agrees to provide in-depth Primary Care and/or Naturopathic Medicine specialty visits, including health care services not billable to health insurance plans that include but are not limited to:
Email messaging between doctors and patients per our messaging policy.
Form completion between visits when appropriate, including, but not limited to: sports physicals, vaccine certificates, FMLA and disability paperwork, re-sending lab orders, prior-authorizations for prescriptions, and imaging orders.
Advocating for reimbursement for naturopathic services.
Between-visit troubleshooting of pharmacy, medications and lab issues.
Between-visit reviewing of documents and communicating with other providers to help with continuation of care.
Patient voluntarily elects to participate in the health care services listed above, offered by Provider, by selecting one of the following plan options:
Recommended for all patients. Includes an enhanced relationship with your doctor, including the comprehensive visits and individually tailored care that you have been experiencing with us, along with priority scheduling. Includes:
Direct email access to your provider via our secure portal. Non urgent as can 3-7 days to reply.
Priority scheduling within 48 hours if necessary for acute/urgent medical appointments.
Priority scheduling within 2 weeks for chronic care follow up appointments.
10% off all supplements purchased from NSNM (and they remain sales tax free).
6 free vitamin B12 shots/year ($150 savings)
10% off hormone pellet therapy costs. (between $30-$50 savings per pellet visit).
Family discounted rate of $150 / month total for 3-6 immediate family members (instead of $79 per person).
Discounts on microneedling, Botox, and other new services coming this year.
$20 off of two massage services each per year with Trinda Hartmann of Lady Reflexo at NSNM.
Ideal for patients who only come in 2-3 times a year and do not want the benefits of a concierge plan. Provider will continue to bill Patient’s insurance for services typically provided in a medical setting while delivering additional services, considered by Patient’s insurance to be ‘non-billable’ or ‘non-covered', for an out-of-pocket fee of $100/visit. The plan includes access to your provider for services such as referrals, prescription refills, emails, and prior authorizations for 30 days after an appointment. After 30 days you will need to schedule another appointment for any follow up. Please note if the Non-Covered Service fee is not paid within 5 days following your appointment then the credit card we have on file will automatically be charged.
This Agreement shall commence on July 1, 2024 for patients of Drs. Lush and Sinclair, and January 1, 2025 for patients of Dr. Tausend, and shall continue until Patient terminates the agreement, which they may do at any time. Patient acknowledges that Provider will need a minimum of 30 days to forward medical records to Patient’s new health care providers, and that Provider will refill any necessary medications for 30 days only. Should Patient elect to re-start this Agreement with Provider, Patient agrees to pay a $200 re-start fee.
Patient agrees to maintain an active credit card on file with our credit card processing system, for recurring Thrive Plan monthly charges, or individual Core Plan visit charges. Refunds are not provided.
Patient acknowledges that there may be times when Patient cannot schedule or communicate with their regular health care Provider due to vacation or illness. Provider will endeavor to have another doctor covering their patient panel, in order to continue to provide timely and appropriate health care services in their absence.
Patient acknowledges that they have carefully read this Agreement and understand their respective rights and responsibilities under this Agreement, signing this Agreement of their own free will. By signing, Patient hereby agrees to the terms of the plan selected above. Patient understands all regular insurance billable charges, including co-insurance, co-pays and deductibles continue to apply even with their plan agreement. Patient authorizes North Seattle Natural Medicine LLP (NSNM), to automatically charge credit card for Concierge or Non-Covered Service Fees.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use: