Automatic Payments. All patients/clients, who are uninsured, insured, or whose insurance does not cover the cost of mental health counseling services are personally responsible for all payments. Any balance not paid for by the end of the scheduled session will be automatically charged to your designated credit card on file. You may request a receipt for services to submit to your carrier for out of network reimbursement. The outcome of such an attempt is between you and the carrier, not Homestead Hope. As a courtesy to you, we may elect to bill your health insurance carrier on your behalf and wait up to but no longer than 60 days for payment. Please remember however, that you are ultimately responsible for payment. After day 60, if the insurance company has not paid the invoice, your credit card will be charged any and all unpaid amounts without further notice. Any double payments made will be immediately refunded to you. Past due fees may be sent to a collection agency and reported to the credit bureau at our discretion. *Client Diagnosis will be determined by Best Practices and recorded on the Progress Notes, along with duration of services. If you have any questions, please call the office. Our staff will be more than happy to serve you. Please provide the information below: Health Savings Account Card Type: _ Cardholder’s Name as embossed on the card: _ __ _ Last Four Digits of Card Number: _ _ Expiration Date: _ Credit Card Type: _ Cardholder’s Name as embossed on the card: _ _ Last Four Digits of Card Number: _ _ Expiration Date: _ Driver License Number: State: ___ _ By signing this Financial Policy form, you are signifying your agreement to its terms and are giving Homestead Hope Counseling Services, LLC permission to process and charge appropriate fees (i.e., three percent (3%) service fee). Your credit card information is not kept on any of our data systems or in charts. _ _ _/___ _ First Client / Patient Name *Phone Number *DOB _ _ * Home Address (Street Address, City, State, Zip) Please TURN PAGE OVER TO SIGN _ _ *Client / Patient Email _ _ _ __ _ Client / Patient Signature Date _ ___ _/ _ Second Client / Patient Name *Phone Number *DOB _ _ * Home Address (Street Address, City, State, Zip) _ _ *Client / Patient Email _ _ __ Client / Patient Signature Date _ __ ___ __
Automatic Payments are sent automatically on an ongoing basis. You set up payment rules based on the frequency, amount, and timing of a payment; however, the amount of an Automatic Payment is fixed and will not fluctuate unless you manually change the amount.
Examples of Automatic Payments in a sentence
At any time and for any reason, Borrower or Lender may voluntarily terminate Automatic Payments.
At any time and for any reason, Borrower or Bank may voluntarily terminate Automatic Payments.
At any time and for any reasons, Borrower or Lender may voluntarily terminate Automatic Payments.
Borrower hereby authorizes Lender to automatically deduct from Borrower's account numbered [_______________] the amount of any loan payment ("Automatic Payments").
At any time and for any reason, Borrower or Bank may voluntarily terminate such Automatic Payments.
More Definitions of Automatic Payments
Automatic Payments means any and all interest or principal and interest installment payments due under the Notes.
Automatic Payments means the payment checks that, pursuant to this Agreement,
Automatic Payments enables you to allocate a portion of each paycheck towards paying your monthly bills. If Automatic Payments is offered through your Program, the only bills for which you currently may be able to use Automatic Payments are credit cards and student loan payments; however, Even may roll out additional bills in the future, such as for utility, cable, or cell phone bills. You can see what obligations you are allowed to pay through Automatic Payments, including any new bills that we may add in the future, by accessing the Even App. All funds under Automatic Payments are held in your CRB Account. You will open your CRB Account as part of the process of signing up for Automatic Payments. The CRB Account is discussed in greater detail below in Section 7. You can turn on Automatic Payments for one, some, all, or none of the types of bills being offered to you and set the amount of the payment for each bill that you would like to automatically pay each month. In accordance with the instructions you set in the App, Even will keep track of the funds you earmark for Automatic Payments towards your monthly bills, and will transfer these funds to the CRB Account on the scheduled paydays. Even will transfer the funds to the CRB Account either as (i) a deduction of funds from your paycheck through payroll, or (ii) a transfer of funds from your Bank Account that you link through the App; one of these options will be made available to you when you sign up for Automatic Payments in the App. For more details on the deduction of funds from your paycheck or the transfer of funds from your Bank Account, see Section 10. Even will make payments with the funds in your CRB Account on each bill you have set up by the due date for each bill. Even will make these payments to the relevant billers out of your CRB Account.
Automatic Payments. Unless Lessor otherwise directs in writing, all payments of Base Rent and the monthly estimated payments of Lessee’s Proportionate Share of Operating Expenses shall be made by electronic payment. Lessee shall execute such necessary and reasonable documents, provide such necessary and reasonable information, and follow such necessary and reasonable procedures as are requested by Lessor from time to time to facilitate such payments. If, by reason of insufficient funds or other reason, any such payment is not fully made and received, such event shall be deemed a failure of Lessee to make the required payment. Payment shall be deemed made by Lessee on the date funds are actually received by Lessor, provided, if Lessee is then in default, Lessor shall have the right to return all or a part of any payment received within ten (10) business days of receipt, in which event the returned amount shall be deemed to have not been paid by Lessee or received by Lessor. Receipt of any funds pursuant to this Paragraph shall not constitute a waiver by Lessor of any Default by Lessee whether or not such Default is known to Lessor.
Automatic Payments payments on the Card Account that Customer authorizes Bank to make via Automated Clearinghouse Debit automatically against a demand deposit or savings account at Bank or another financial institution designated by Customer for an amount designated by Customer but not less than the minimum amount due.
Automatic Payments means any and all interest or principal and interest installment payments due under the Notes. " Bank " has the meaning ascribed to such term in the preamble of this Agreement.
Automatic Payments means transactions initiated by an external financial