Past Due Accounts. If your account become past due, we will take necessary steps to collect this debt. If we have to refer your account to the collection agency, you agree to pay all of the collection costs which are incurred. If we have to refer collections of the balance to a lawyer, you agree to pay all lawyer’s fees which incur plus all court costs.
Past Due Accounts. If your account becomes past due, we will take necessary steps to collect this debt. If we have to refer your account to a collection agency, you agree to pay any and all of the collections costs which are incurred. If we have to refer collection of the balance to a lawyer, you agree to pay all lawyers’ fees which we incur plus all court costs. In case of suit, you agree the venue shall be in Xxxxx County, Iowa. PAGE 1 OF 2 PATIENT INITIALS WAIVER OF CONFIDENTIALITY: You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that your received treatment at our office may become a matter of public record. DIVORCE: In case of divorce or separation, the party responsible for the account prior to the divorce or separation remains responsible for the account. After a divorce or separation, the parent authorizing treatment for a child will be the parent responsible for those subsequent charges. If the divorce decree requires the other parent to pay all or part of the treatment costs, it is the authorizing parent’s responsibility to collect from the other parent. TRANSFERRING OF RECORDS: You will need to request in writing, and pay a reasonable copying fee if you want to have copies of your records sent to another doctor or organization. The amount of the fee is dependent on the number of pages we need to copy. You authorize us to include all relevant information, including your payment history. If you are requesting your records to be transferred from another doctor or organization to us , you authorize us to receive all relevant information, including you payment history. WORKERS COMPENSATION: We require written approval/authorization by your employer and/or worker’s compensation carrier prior to your initial visit. If your claim is denied, you will be responsible for payment in full.
Past Due Accounts. We will send monthly statements to the address on file for the responsible party on the account. A maximum of 3 statements will be sent regarding any account balance. Any account that has an unpaid balance over 30 days will have a finance charge (15%) added monthly to the account as well as a $25 late fee. Any account that has a past due balance of 90 days or more or any account that has a financial contract in default will have additional steps taken to collect those debts. If we have to refer your account to a collection agency, you agree to pay 33.3% attorney fees and all court costs incurred. Any returned check will be subject to a $35 bank charge as well as late fees, if applicable. Effective Date: Once you have signed this agreement, you agree to all of the terms and conditions contained herein and the agreement will be in full force and effect. RESPONSIBLE PARTY (PRINTED) : ______________________________________ RESONSIBLE PARTY (SIGNATURE): _____________________________________ DATE: _________________
Examples of Past Due Accounts in a sentence
Past Due Accounts Accounts are considered past due if the account is not paid by the fifth (5th) of each month.
Past Due Accounts An account will be past due on the 12th of the month and will be assessed at $15.00 late fee.
Past Due Accounts - Past due accounts may be reported to a credit bureau and referred to a collection agency or attorney for collection.
Past Due Accounts Xxxxxxxxx agrees to pay Porinetia Adventures all amounts due and owing forthwith.
Date: Signature: Original: to Student Accounts Office Copy: to Student Past Due Accounts Information 9 Grades, transcripts, and future registration will be withheld for non -payment of tuition and other charges in accor- dance with university policies.
More Definitions of Past Due Accounts
Past Due Accounts. All accounts due to Xxxxx Precast Concrete Products that are not paid when due shall bear interest, beginning thirty(30) days after the date of invoice, at a monthly interest rate of 1.5%. Xxxxx Precast Concrete Products reserves the right to place a hold an any pending or future orders by a customer with a past due account and change the account status to COD and/or prepaid status. Xxxxx Precast Concrete Products reserves the right to grant additional time to repay delinquent balances in its sole discretion. WARRANTY: Xxxxx Precast Concrete Products makes no warranties, expressed or implied on any product, including any warranty of merchantability or fitness for a particular purpose. The amount of recovery under warranty shall be limited to the purchase price of the product. Any damage to product or material must be noted on the delivery ticket at the time of receipt of the product or material or the claim is unenforceable. Under no circumstances is the customer entitled to any claim or payment for loss of profit, or any other money damages, special, indirect, incidental, or consequential. Product sold by, but not manufactured by Xxxxx Precast Concrete Products are warranted only to such extent as said products are warranted to Xxxxx Precast Concrete Products by the manufacturer. COLLECTION EXPENSE: Customer agrees to pay for reasonable attorney fees and related expenses incurred by Xxxxx Precast Concrete Products to protect its legal rights, including, but not limited to Xxxxx Precast Concrete Products legal case. ACCEPTANCE: Customer has read and hereby agrees to the terms and purchase conditions set forth in this agreement. Customer waives notice of acceptance of this agreement and any obligations to which it applies. The terms of the Purchase Agreement will continue in full force and effect until terminated by Xxxxx Precast Concrete Products. MODIFICATION OF TERMS: Terms of sale can only be modified by written agreement expressly referencing the Purchase Agreement which is signed by the Purchaser and Xxxxx Precast Concrete Products. Any attempt to modify any of the terms of the Purchase Agreement by Purchase Order, or otherwise without express written consent of Xxxxx Precast Concrete Products shall be void and unenforceable. INCORPORATION BY REF: This Purchase Agreement shall be incorporated by reference in any quote or order placed with Xxxxx Precast Concrete Products. APPLICABLE LAWS: This agreement shall be governed by the laws of the State of Okl...
Past Due Accounts. Please make timely payments to your account to ensure continuation of services for your child. In the event that an account becomes past due (i.e., not paid by the first session of the month), your child’s speech-language services will cease until payment is received. (client signature) I understand and agree to the payment policy outlined above and consent to the billing of my insurance for services rendered. Fee Schedule (Cost for Services) Service Cost Evaluation Services Stuttering/Fluency Evaluation (92521) - Includes consultation with parent and file review, 30-45 minutes of direct contact, approximately 1-1.5 hours of analysis and interpretation and includes a thorough report. $250 Articulation/Phonology Evaluation (92522) - Includes consultation with parent and file review, 30-45 minutes of direct contact, approximately 1-1.5 hours of analysis and interpretation and includes a thorough report. $250 Comprehensive Speech-Language Evaluation (92523) - Includes consultation with parent and file review, 1-2 hours of direct contact, possibly over 2 sessions, followed by approximately 2-3 hours of analysis and interpretation and includes a thorough report. $350 * All testing can also be completed in Russian, with an English-language report provided. Therapy Services Individual Speech Therapy Session (92507) – Sessions are 45 minutes in length. Pricing is inclusive of preparation time, resources/materials made for your child’s therapy, record keeping, home programming, quarterly progress reports, and consultation with other professionals to coordinate therapy. $110 *10% discount available for payments at or ahead of time of service.
Past Due Accounts. An account becomes past due 30 days after it becomes patient responsibility. Your balance will be communicated by statement every month. If your account becomes past due, we will take necessary steps in contacting you to collect this debt. If these attempts do not generate a response from you, your account could be subject to the following fees: Finance Charges (currently 1.5%), In House Collection Fees, Collection Agency fees and any Attorney fees. RETURNED CHECKS: If your check is returned, your account will be charged an administrative fee (currently $25) plus any associated charges assessed to us by our bank for the handling of the returned item. CANCELLATION / NO SHOW POLICY: At ProActive Physical Therapy, we want to provide you with the best possible care. Attending your scheduled appointments is a necessary part of the treatment process. Appointments missed or cancelled with less than 24 hours notice are subject to a $25.00 cancellation fee. This fee must be paid before a new appointment can be scheduled. SELF PAY ACCOUNTS: If you do not have health insurance we do offer self pay plans. Self Pay payments are due at the time of service. Please speak to our Clinical Director for more information. If you are unable to provide us with your health insurance, worker's compensation insurance or personal injury insurance within 48 hours of your first visit, you may be turned over to a self pay account status. Even if you provide us with your insurance information after the initial 48 hour period we reserve the right to refuse to bill your insurance.
Past Due Accounts. If your account becomes past due, we will take the necessary steps to collect this debt. If we refer your account to a collection agency, you agree to pay all of the collection costs, which are incurred. If we refer collection of the balance to a lawyer, you agree to pay the lawyer’s entire fee, which we incur, plus all court costs. In case of a suit, you agree the venue shall be in Chesterfield County, Virginia.
Past Due Accounts. If your account becomes past due, we will take necessary steps to collect this debt. If we must refer your account to a collection agency, you agree to pay all the collection costs which are incurred. If we must refer collection of the balance to a lawyer, you agree to pay the lawyers' fees which we incur plus all court cost. In case of lawsuit, you agree the venue shall be in Forsyth County, NC. Once your account goes to collections you will be discharged as a patient and asked to transfer your records to another practice. Your delinquent account may also be reported to all three credit bureaus. Waiver of Confidentiality: You understand if this account is submitted to an attorney or collection agency, if we must litigate in court, or if you are past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record. Divorce: In case of divorce or separation, the party responsible for the account prior to the divorce or separation remains responsible for the account.
Past Due Accounts. If your account becomes past due, we may need to take necessary steps to collect this debt. This may include contacting the person listed as the Emergency Contact on your patient data sheet. If we have to refer your account to a collection agency, you agree to pay all of the collection costs which are incurred. If we refer your account to a collection agency, we will add a surcharge of 30% to your balance. If we have to refer collection of the balance to a lawyer, you agree to pay all lawyers’ fees which we incur plus all court costs. Missed Appointment Fee: A $25 fee may be charged for appointments cancelled with less than 24 hours notice. A $50 fee will be charged for no show or missed appointments. This fee must be paid before a new appointment is made. This fee is not billable or payable by insurance. Patients with more than two missed appointments will be discharged from therapy and referred back to their physician. We understand that emergencies do occur and will attempt to make reasonable accommodations for that. TYPE OF CLAIM Is this injury due to an accident? □ Yes □ No Date of accident: Was this injury due to a motor vehicle accident (either in the past or current)? □ Yes □ No Date of injury: Did this injury occur on the job? □ Yes □ No Do you have an open worker’s compensation claim? □ Yes □ No Date of injury: THIS INFORMATION MUST BE COMPLETELY FILLED OUT ON THE PATIENT DATA SHEET Waiver of Confidentiality: You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record. I have been informed of my estimated financial responsibility and agree to the terms and conditions as stated on this form. Patient Name: Responsible Party (if not the patient:): Signature: Date: South Lane Physical Therapy ♦ 00 Xxxxxxx Xxxx, Xxxxx X ♦ Cottage OR 97424 ♦ Ph. 000.000.0000 ♦ Fax 000.000.0000
Past Due Accounts. Past Due Accounts" shall mean those Accounts which, as of the Closing Date, are more than ninety (90) days past due.