The practice policies referred to on the registration form are located here in this section. Please read them and sign your registration form accordingly, indicating that you have received, read and understand our policies and will comply with them.
Medical Weight Loss Program
All visits are online via Telemedicine. Patients are seen by Dr McClendon for their initial visit at which point an individualized Weight Loss Program is devised based on the patient’s medical history and goal weight. Monthly follow up visits are required to ensure success in the Weight Loss Program. Once goal weight has been achieved, patients will be transitioned to the Weight Maintenance Program to maintain their weight.
Due to the high demand of Dr McClendon’s weight management appointments, patients who have missed an appointment, and/or an interruption of the Weight Loss Program such as a period of absence of 3 months or more, will be converted to Inactive Patients and subject to dismissal and discharge from the practice.
Inactive Patients who wish to restart weight loss services with Dr McClendon will restart the program at Self Pay pricing. We do not bill insurance when the Weight Loss Program is restarted. They will require an initial visit with Dr McClendon to implement the new weight management plan and subsequent follow up visits subject to the current Self Pay pricing (not covered by insurance).
Weight Maintenance Program
All visits are online via Telemedicine. Patients who have previously achieved their goal weight with Dr McClendon’s Weight Loss Program will be placed in the Weight Maintenance Program to maintain their weight. Visits are scheduled every 3 months while in the Weight Maintenance program.
Patients who have not been seen by Dr McClendon for greater than 3 months, have regained weight and want to restart weight loss, they will need to be restarted on a weight loss regimen. As a result, they will need to restart the Medical Weight Loss Program. This will require an Initial Visit, and subsequent visits at Self Pay pricing (not covered by insurance) to implement the new Medical Weight Loss Program.
Due to the high demand of Dr McClendon’s weight management appointments, patients who have missed an appointment will be converted to Inactive Patients and subject to dismissal and discharge from the practice.
Patients who have missed an appointment and/or have had an interruption in the Weight Loss Program such as a period of absence of 3 months will be converted to Inactive Patients. Inactive patients are subject to dismissal and discharge from the practice.
Patients who restart weight loss services with Dr McClendon or more will restart the program at Self Pay pricing. We do not bill insurance when the Weight Loss Program is restarted. They will require an initial visit with Dr McClendon to implement the new weight management plan and subsequent follow up visits are subject to the current Self Pay pricing.
Patient Financial Responsibility Agreement
The Weight Management services you seek here at Bari-Med M.D. PLLC imply an obligation on your part to ensure payment in full is made for services you receive. This Patient Financial Responsibility Agreement will assist you in understanding that financial responsibility and your consent to Bari-Med M.D. PLLC Terms and Conditions.
Responsibility. I understand that I am ultimately responsible for all payment obligations arising out of my treatment and care and I guarantee payment for these services. My co-payment is due at the time of service. I am responsible for deductibles, co-payments, co-insurance or any other patient responsibility amounts indicated by my insurance carrier or for any services not covered by my insurance. In the event I am unable to keep my appointment, Bari-Med M.D. requires a 24-hour notice, or I may incur a $100 cancellation fee. I must notify Bari-Med M.D. in advance by calling 703-869-7220 or cancelling on the patient portal 24 hours in advance. As a result of one or more no-shows, Bari-Med M.D. reserves the right to discharge a patient from the practice. Patients who have missed an appointment and/or have had an interruption in their weight loss journey such as a period of absence of 3 months or more will be converted to Inactive Patients. Inactive Patients are subject to dismissal and discharge from the practice. Inactive Patients who wish to restart weight loss services with Dr McClendon will restart the program at Self Pay pricing. They will require an initial visit with Dr McClendon to implement the new weight management plan and subsequent follow up visits are subject to the current Self Pay pricing.
Insurance Policy. Bari-Med M.D. accepts the following insurances: Aetna, Blue Cross Blue Shield (BCBS) , Carefirst, United Healthcare (UHC) and Multiplan (PHCS). All others would be considered “Self Pay”. It is my responsibility for knowing and understanding my insurance policy, including the coverage benefits and policy limitations. I understand that I am personally responsible for any payment when: (i) my health plan requires prior authorization/referral by a primary care provider (PCP) before receiving services, and I have not obtained such an authorization or referral; (ii) I receive services in excess of the authorization/referral; (iii) my health plan determines the services I received are not medically necessary and/or not covered by my insurance plan; (iv) my coverage has lapsed/expired at the time of services are rendered; (v) I have chosen to utilize my out-of-network benefits; or (vi) I have chosen not to use my health plan coverage for services I receive.
Payment Arrangements. Whether or not I have insurance or are self-pay, payment of my account balance is due within thirty (30) days of receipt of my billing statement. If a balance of $200.00 or greater has been unpaid for 30 days or greater, we reserve the right to hold further Weight Management visits until the balance has been paid. If my account is over ninety (90) days past due, my account will be in default, may be referred to a collection agency, all visits may be automatically cancelled, and I may lose my ability to be seen at Bari-Med M.D. as a result of my account status.
Payments Accepted. I understand I can make payments by credit card, debit cards, or check (Visa, Mastercard, American Express or Discover). When paying by credit card, I hereby authorize Bari-Med M.D. PLLC to charge my credit card for fees incurred for medical treatment. By signing this agreement, I acknowledge the charges described on this form, assume full responsibility for said charge. I acknowledge and accept Bari-Med M.D. PLLC Terms and Conditions.
Payments by Check. If my check payment is returned or declined for any reason, my account will be charged a surcharge of $35.00 in addition to any costs assessed or charged by the bank. Checks returned to the office are also subject to further collections unless a valid method of payment is forwarded upon request. After one (1) returned check has been received by Bari-Med M.D., my personal checks will no longer be accepted, and I will be responsible for using another method of payment.
Collection of Anticipated Charges. For Weight Management services, Bari-Med M.D. may collect my anticipated financial responsibility for such services prior to delivery of services, or prior to scheduling Telemedicine visits. Bari-Med M.D. will determine an estimate of the anticipated amounts owed based on the current contracted amounts and fee schedules with my insurance. I will not hold Bari-Med M.D. responsible for incorrect/inaccurate information provided by my insurance carrier regarding my insurance benefits or benefit plans. Bari-Med M.D. does not accept responsibility for incorrect information given by me or my insurance carrier regarding my insurance benefits or benefit plans. If an account balance remains due after the claim has been processed and amounts collected for anticipated charges have been applied, I understand I will be held responsible for the remaining amount and am ultimately responsible for payment.
Non-Payment of Account. Should collection proceedings or other legal action become necessary to collect my overdue or delinquent account, I understand Bari-Med M.D. has the right to disclose to an outside collection agency or attorney all relevant personal and account information necessary to collect payment for services rendered. I am responsible for all costs of collection including, but not limited to: (i) late fees and charges and interest due as a result of such delinquency; (ii) a $50.00 collection agency fee will be added to outstanding balances placed with a collection agency; (iii) interest of 10% per year will be accrued on the principal balance placed with the agency; (iv) all attorney/court costs and fees incurred in the collection process; and I acknowledge that if my account is referred to a collection agency, legal representative , court, or when the past due status is reported to a credit reporting agency, it may have an adverse effect on my credit history. Once my account is placed with a credit/collection agency, I am responsible for communicating with their offices for payment. I may lose my ability to be seen at Bari-Med M.D. as a result of my account being sent to a collection agency.
Authorization to Contact. I authorize Bari-Med M.D. personnel to communicate with me by mail, voicemail messages, and/or email according to the information provided in my patient registration information and my patient portal setting preferences. Bari-Med M.D., or any agent or servicer of my patient account, may use any information I have provided, including contact information, email addresses, cell phone numbers and landline numbers to contact me for purposes related to my health and my account, including debt collection. I authorize Bari-Med M.D. to use this information in any manner consistent with the information I have provided, including mail, telephone calls, emails or text messages. I expressly consent to any such contact being made by the most efficient technology available, including automatic dialing/emailing or similar equipment, or pre-recorded or other messages.
Acknowledgment. I understand I am ultimately responsible for payment for the services I receive at Bari-Med M.D., regardless of my health insurance coverage. I understand Bari-Med M.D. will not act as administrator to resolve my personal financial agreements in regard to my medical care. I have had the opportunity to read this financial statement in its entirety.
I consent to and agree to the aforementioned policies of Bari-Med M.D. PLLC and understand they may be changed without notice.
No Show/Missed Appointments and cancellations made within 24 hours of appointment:
Due to the high demand of Dr McClendon’s weight management appointments, any patient who misses one or more of their appointments will be placed in Inactive Patient status. There is a strict “No- Show/Missed appointment” fee of $100 applied to each appointment missed or cancelled within 24 hours of the appointment time. In addition, Inactive patients are subject to dismissal from Medical Weight Management Services.
In the event you are unable to keep your appointment, we require a 24-hour notice, or you may incur a $100 cancellation fee for office visits. Notifying us in advance will enable us to accommodate the many requests we receive daily from other patients for immediate/sooner appointments.
Late Policy: To better serve all our patients, we reserve the right to reschedule your appointment if you are more than 15 minutes late. If you are having difficulty logging into the Telemedicine appointment, you are required to notify our office by calling 703-869-7220 or sending a message on the Patient Portal within 15 minutes of your appointment time. If this is not done, then the appointment will be marked as a “no-show” and you may incur a “no- show” fee of $100. Please call ahead if you may be late, and in turn we will do our best to be considerate of your valuable time.
Credit card on file: At Bari-Med M.D. PLLC, payment is due at the time of service. We securely store a credit card on file to run for services rendered. Once your card is approved by our credit card processor, our system saves the last 4 digits of your card number and the expiration date. While we will do our best to aid you in resolving any insurance issues such as referrals, co-insurance or deductibles, it is your responsibility to know your insurance benefits, requirements and coverage level. All patients are required to sign a credit card authorization form, in addition to updated registration & administrative documents. Patients who continue to be seen at Bari-Med M.D. after the effective date of 1/1/2023 constitutes your acceptance of this requirement. Patients who decline or revoke their consent will no longer receive services at Bari-Med M.D. PLLC.
Follow Up appointments: Monthly follow up appointments are required during the Medical Weight Loss Program to ensure success and safety. One week prior to the follow up appointment, the “Bari-Med M.D. Follow up Form” is sent via email. This must be completed on the Patient Portal PRIOR to each follow up appointment. Dr McClendon reviews this form prior to your visit to ensure that your treatment plan is optimized and efficiently address any concerns that may arise. Pictures of your progress should also be sent to [email protected] for Dr McClendon to review and get an accurate assessment of your weight loss.
Completion of Forms: Due to the administrative burden, $10 minimum fee will be assessed for the completion of any patient requested forms. This will be collected prior to completion of the forms.
We treat others with the utmost respect and care. We reserve the right to discharge and deny services to patients for noncompliance, and mistreatment and antagonistic behavior to Bari-Med M.D. staff.
Please click below to access Bari-Med M.D. Notice of Privacy Practices.
Returns & Refund Policy:
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. As a result, we do not accept returns nor issue refunds on any Meal Replacement Products.
Additional non-returnable and non- refundable items:
- Health and Personal Care Items (Blender Bottle and Shaker Cups)
- Bari-Med M.D. services
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