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HEROES’ HEALTH & WELLNESS
FINANCIAL POLICY
Thank you for choosing Heroes’ Health & Wellness to aid in maintaining your health. We are committed to providing you with the best possible care, and are pleased to discuss our professional fees with you at any time. Your clear understanding of your financial responsibilities is important to our professional relationship. The following is a statement of our policy; which we require you to read, agree to, and sign prior to receiving treatment.
PAYMENT METHODS & RESPONSIBILITIES:
-CASH: Payment is due at the time service is rendered.
-CHECKS: Personal checks may be accepted at the clinic’s discretion. A valid driver’s license will be required and may be photocopied.
-CREDIT / DEBIT CARDS: Visa, Mastercard, Discover, & American Express credit or debit cards are accepted by the clinic with proper id.
- L&I, PIP (MVA), 3rd Party, or Medical Insurance Billing:Once your insurance coverage for massage therapy has been verified and approved, we will gladly bill directly to, and accept payment from your insurance company/ and or attorney. It should be understood that all services are charged to you, the patient, who is legally responsible for these fees. (Please refer to the NON-PAYMENT BY CLIENT and/or OUTSTANDING ACCOUNT BALANCES section below regarding interest accrual on account balances.)
In order to bill your insurance company, we are required to send copies of the treatment notes which we keep, as well as your initial intake forms. Your signature below indicates that you have released files for this purpose.
By billing your insurance company for you, we are extending you credit. If you prefer not to answer the questions on the insurance form; you may pay-in-full the therapeutic massage billable rate of $140.00 per hour, at the time of your treatment. You will be provided the necessary documentation to be reimbursed by your insurance company.
-RETURNED CHECK or CREDIT / DEBIT CHARGES: The client will incur a $35 fee, as well as any financial or legal fees accrued by the clinic. Should this occur, all future services must be paid for in cash only. No future services shall be rendered until the total amount due is paid. (The clinic, may at its discretion, enter into a repayment schedule with client. This will have its own written financial agreement.)
-LATE CANCEL & NO- SHOW APPOINTMENTS: You will be charged 50% or $35 (whichever is greater) for any late cancellation (less than 24 hours notice) or no-show appointment. (Please refer to the posted clinic policies for more details.) These charges will NOT be billed to your insurance company. They are your responsibility and will be due prior to receiving further services. If you were using a pre-paid massage package session for that appointment; a removal of a session will be taken from your package. The removed session may be redeemed if the fee of 50% or $35 (whichever is greater) is paid readily.
-NON-PAYMENT BY CLIENT and/ or OUTSTANDING ACCOUNT BALANCES: Any payment or fees owed to the clinic not paid in a timely manner will be turned over to an outside collection agency. The client will then also be liable for services incurred by the clinic for the retention of the collection agency. All Balances will accrue interest at 1% per month/ 12% per year until the full account balance is satisfied.
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