Credit Card on File (CCOF) Policy
Cognizant Behavioral Health Services will implement a policy requiring all patients to provide a credit card on file effective March 26, 2020. The current healthcare market and insurance policies are increasingly transferring costs to the subscribers and the insured. All the deductibles and copayments for insurance plans are not known to you or us at the time of your visit. Similar to many other businesses, including healthcare practices, we ask that you provide your credit card number at the time of making an appointment. Our CCOF Policy allows Cognizant Behavioral Health Services to easily process time of service payments, deductibles (if applicable), No Show & late cancellation fees and co-insurance amounts which may remain as your out of pocket expenses after your insurance company reimburses Cognizant Behavioral Health Services for the services provided. This eliminates the need to send the paper statements for outstanding balances. You will be advised of this charge and a receipt will be sent to you electronically. Cognizant Behavioral Health Services will store CCOF information in a secure electronic form that is PCI-DSS compliant within our electronic billing system. Hence no individual has direct access to your credit card information at any time. Our CCOF Policy in no way will compromise your ability to dispute a charge or question your insurance company's determination of payment.
The undersigned has read and agrees to the above CCOF policy and authorizes Cognizant Behavioral Health Services to save the credit card indicated below on file and charge it for the services offered.