Financial and
Cancellation Policy

Mitogenesis requires a credit card to hold or secure an appointment.

Please complete the credit card authorization provided to hold your appointments and for charges as stated herein. Your credit card information is stored securely using encryption security software, and we can only see the last 4 digits. Your credit card on file will be charged after your appointments are over unless another valid form of payment is provided, and in the case of a late cancellation or missed appointment, in accordance with our Cancellation, Rescheduling, and Missed Appointment Policy set forth below.

Fees:  

• All fees are for appointments and services only and do not include the cost of any supplements or laboratory testing. Lab interpretation requires a scheduled visit with your Mitogenesis provider at the normal appointment rates.

• For comprehensive treatment programs, 30% of the estimated treatment program cost is required to be paid upfront and is non-refundable to cover the initial supplies needed for starting the program. When the initial or current funds for your comprehensive program are depleted, an additional 30% of the estimated treatment cost must be deposited into your account. Treatments will be deducted from these funds, and once they are used up, a final 30% of the estimated treatment cost must again be added to your account. No further services will be provided until required funds are added to your account.  

• Please note that there are no refunds on services already received, custom compounded products, peptides, or opened supplements.  

• All fees listed and provided are cash prices. If you plan to use a credit card, the card processor will add a 3.00% surcharge for processing your credit card.

Payment Due at Time of Service:  

• Payment is due in full at the time of service and/or purchase.

• For your convenience, we accept cash, checks, Visa, and MasterCard. You can also use your Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for services and lab tests; however, we cannot guarantee your HSA or FSA card issuer will approve the transaction.

• Checks should be made payable to WODR LLC DBA Mitogenesis Regenerative Medicine. An additional $50.00 fee will be charged for any payment returned for insufficient funds or otherwise dishonored.  

• Your credit card on file will be charged at the conclusion of your appointment unless you pay at the time via cash, check, or another valid credit card.

• If payment is not made or if there is a chargeback or billing dispute, Mitogenesis is authorized to provide the necessary information to the credit card company about the services provided to you and a copy of this form to obtain payment. You are ultimately responsible for payment in full and accept full responsibility for any fees incurred, including but not limited to legal fees, collection agency fees, and all other expenses incurred in the collection of past-due accounts.

Patient Portal Messages and Phone Calls: Patient portal messages and phone calls require the same time and expertise as scheduled visits and consultations but do not take the place of office visits and consultations. Phone calls and patient portal communication that cover new material, require new information, or take 10 minutes or more of your Mitogenesis Provider's time will be billed at the hourly rate of $350/hour (billable at 15-minute increments). For patient safety to ensure accurate diagnosis and treatment, you will be asked to make an appointment if there is a new problem or your questions or concerns are extensive.

Medical Forms: Please allow up to 10 business days after you have signed the medical release form to receive your records or forms.

No Insurance or Medicare: Mitogenesis Regenerative Medicine is a fee-for-service business and does not accept or submit insurance or Medicare claims or payments. Mitogenesis is not contracted with any insurance plans, does not participate with Medicare, and does not bill insurance or Medicare for any services rendered. Upon request, we will provide you with a statement showing your payment and a coded superbill that you may submit to your insurance company (not Medicare) for reimbursement at an out-of-network rate depending on your individual plan. Our services are not eligible for Medicare reimbursements. We cannot and do not guarantee that your insurance company will reimburse you for your appointments. Payment reimbursement is subject to your insurance plan. You are ultimately responsible for the cost of your care.

Lab Tests: Dr. Schottenstein orders a variety of labs, both conventional and specialty, based on patient need. Insurance may cover some labs that are ordered, depending on your individual plan, but if you choose to use your insurance rather than pay the lab company directly, we cannot guarantee what your insurance may cover or what your out-of-pocket costs may be. It is the patient’s responsibility to understand his or her insurance coverage.

The amount you may have to pay for lab tests and the extent of your insurance coverage differ significantly among different networks. To prevent the stress of unexpected bills, if you choose to use your insurance, we recommend you contact your insurance company so you can have a thorough understanding of your lab benefits prior to completing any lab tests.

If you have a high-deductible health plan, we can use a discount lab provider to run blood tests at a fraction of the retail price. Most testing is also covered under Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). Prior to ordering any tests, we will discuss the necessity and its cost with you.

Cancellation, Rescheduling, and Missed Appointment Policy: We require cancellations or changes to be made at least 48 hours prior to your scheduled appointment. Monday appointments must be cancelled by 5pm MST the Friday prior. For any cancellation made with less than 48 hours' notice and any missed appointments (no-shows), your credit card on file will be charged the full amount of the scheduled appointment. Please contact us by phone or patient portal for cancellation. Cancellations are only confirmed if you have received verbal or written confirmation from us via the patient portal. Thank you in advance for your cooperation.

Late Arrival Policy: We are committed to being on time with appointments. If you are running late, please call the office. If you arrive late for your appointment, your appointment will end at the scheduled time, and you will be charged for the full length of the originally scheduled appointment.

By signing below, you agree that you have read, understand, and agree to the terms of Mitogenesis Regenerative Medicine's Financial and Cancellation Policies; accept full financial responsibility for services rendered at time of service; and give Mitogenesis Regenerative Medicine permission to charge your credit card if you miss, cancel, or reschedule an appointment with less than the required notice and for other charges as stated herein.