PROFESSIONAL FEES AND PAYMENT. Our providers set their own fees. Please discuss this during your visit. If you want to set up a payment plan, you may also discuss this during your visit. You will be expected to pay for each session at the time it is held, unless another schedule is agreed upon or unless you have insurance coverage. If we file your insurance, you are expected to make your co-pay at each visit. Payment schedules for other professional services (such as report writing, extended telephone conversations, consulting with other professionals with your permission, preparation of records or treatment summaries, or legal testimony) will be agreed to when they are requested and are not insurance reimbursable. We accept cash, personal checks, Visa, Discover, and MasterCard. There will be a $25 service charge for returned checks. If your account has not been paid for more than 60 days and you have not made arrangements for payment, we have the option of using legal means to secure the payment. This may include collection agency or small claims court which will require disclosing otherwise confidential information. In most collection situations, the only information released regarding a patient’s treatment is his/her name, the nature of services provided, and the amount due. [If such legal action is necessary, its costs will be included in the claim.]
Appears in 4 contracts
Samples: Provider Patient Services Agreement, Patient Services Agreement, Patient Services Agreement
