Fees and Payment Policy. 5.1. The fee for my Services will comprise of a single session which may be discounted if you purchase several sessions in advance or if you purchase sessions within a work programme.
Fees and Payment Policy. Payment is expected after each visit. We accept cash, checks, credit and debit cards and dental insurance. The College of Dentistry is a participating provider with Iowa Medicaid (Title XIX) the Iowa Dental Wellness Plan and some other plans. You will be responsible for any deductibles, co-payments, and final balance not paid by insurance. A down payment may be required for some dental treatment. Payment arrangements may be made with the approval of the Business Office. • Emergency Treatment. Emergency treatment is available by appointment at the College during clinic hours except for holidays. Contact our Call Center at (000) 000-0000 during clinic hours (8:00 am – 5:00 pm) to make an appointment. After-hours emergency care is available through the University of Iowa Hospitals and Clinics by calling (000) 000-0000. Ask for the dental General Practice Resident on call. If you are seen in the emergency room, there will be a charge for emergency room services, in addition to any charges for dental treatment. • Children/Dependent Adults in the Clinics. To help ensure the safety and comfort of all, the College asks that patients make their own care arrangements for young children and dependent adults during dental appointments. Children and dependent adults are not permitted in the dental treatment areas if they do not have a dental appointment and may not be left unsupervised anywhere in the building or on the grounds. • Parking. An hourly fee is charged for parking. Patients who are here at least three hours and receive a parking validation card from a clinic, will receive the lowest possible parking rate. I understand the above conditions and accept that my failure to comply with these rules may result in my discontinuance as a patient at the University of Iowa College of Dentistry and Dental Clinics. Patient signature: Date: Parent/legal guardian signature: Relationship: This section to be filled in by the College of Dentistry: Patient referred to: Faculty signature Date
Fees and Payment Policy. A non-refundable $30.00 registration fee is required at the time of enrollment. For those participants on Medicaid, the application fee will not be covered by insurance; therefore, it is the responsibility of the families to pay for the application fee. The daily program fee is $73.00, which includes continental breakfast, lunch, beverages and snacks. A minimum of two days weekly attendance is required. The initial tuition is due and payable before the participant’s entry date. Fees are due and payable on the fifteenth of each month. If payment is not received by the fifteenth day of the month, a participant will not be accepted at St. Xxxxxxx Adult Day Center the next business day. Payment may be made by check, cash, or credit card. Checks shall be payable to Franciscan Care Services. In the event of illness, please notify St. Xxxxxxx Adult Day Center at (000) 000-0000 the day before or the morning of the first absence. Participants planning vacations or other extended absences are required to notify St. Xxxxxxx Adult Day Center one (1) month prior to the upcoming month of the absence, in writing. Transportation Agreement Participants shall arrive at SFADC no earlier than 6:30 a.m. Pick-up must occur no later than 5:30 p.m. or late pick- up charge will apply. 5:31 p.m. - 5:45 p.m. = $15 5:46 p.m. - 6:00 p.m. = $25 $25 for each additional 15-minute interval after 5:46 p.m. Participant will be picked up by: (Check one) Family Member Handi-Van (Handi-Van transportation is to be arranged by family/caregiver) Taxi Other, please specify: rev. 12/2019 St. Xxxxxxx Intergenerational Center, St. Xxxxxxx Adult Day Center, 91-0000 Xxxxx Xxxxxx, Xxx Xxxxx, Xxxxxx 00000, P: 681-0100; F: 380-4244 Medications Policy As prescribed by Hawaii Administrative Rules §17-1424-16(a) (6), Staff may supervise or remind a participant about the need to take a prescribed medication that is provided to the Center by the family on a daily basis; Medications MUST “be kept in their original container bearing the prescription label which shows the date filled, the physician’s directions for use and the adult participant’s name”; and “Shall be stored out of reach of participants and returned to the participant or responsible family member at the end of each day.” Medication shall only be supervised. Participant will be reminded to take the medication and staff will ensure that it is taken correctly. State law prohibits staff from directly administering the medication.
Fees and Payment Policy. The Person "Responsible for Payment" (as noted in the Contract for Services) will be financially responsible for payment of such services. The Person Responsible for Payment is financially responsible for paying funds prior to or at the time services are provided. If services are terminated and treatment is no longer necessary, any balance of funds for services will be refunded. Normally this will be within 30 days. The standard fee for a session is $110.00 for therapy and parent consultation. In some cases I will have sliding fee appointments available, but please enquire about this prior to signing a treatment agreement. The standard therapy session is approximately 50 minutes long. Intake sessions may be scheduled for 90 minutes, depending on the complexity of the case. The "Person Responsible for Payment" is required to sign the form, "Contract for Services", which explains the fees and collection policies. Your insurance policy, if any, is a contract between you and the insurance company and we are not part of the contract with you and your insurance company. You are not considered a client or patient unless you have a signed contract with us to provide services. As a service to you, I will provide you with a monthly billing statement should you request it. In most cases I can also provide you with a complete retrospective of your billing history if you request it. If you become involved in legal proceedings that require your provider's participation, you will be expected to pay for all of my professional time, including preparation, consultation, and transportation costs, even if I am called to testify by another party. Because of the difficulty of legal involvement, I charge $150 per hour for preparation and attendance at any legal proceeding. Payment methods for all services include checks, cash, or credit cards including Visa or MasterCard.
Fees and Payment Policy. Company shall charge each Seller a fee per transaction (“Transaction Fee”). In addition, Company may charge each Buyer a delivery fee (“Delivery Fee,” together with the Transaction Fee, the “Fees”). Such Fees can be found on the Product purchase screen.
Fees and Payment Policy. You will receive a copy of my fee schedule. You will be expected to pay fees in full at the time of the visit, unless you are using health insurance with which I am contracted. In this case, co-payments and deductible amounts (if you have a deductible) are due at each session. Cash, checks, and credit cards are accepted. If your insurance is not in effect at a given time, you will be responsible for the full charge of the session. I will be happy to print statements for submission to insurance companies for those insurances with which I am not contracted. Checks returned by the bank for insufficient funds will incur a charge of $20.00.
Fees and Payment Policy
