Thank you for choosing Beacon of Hope for your care. To ensure a smooth, timely billing process, we require a valid credit card on file. We may use this card for copays, coinsurance, deductibles, missed appointments, and other patient-responsibility charges not covered by insurance.

We accept Visa, Mastercard, American Express, Discover, and other major credit cards.

Important Information:

• All telehealth visits require a valid credit card to be on file before the appointment.
• Copays, coinsurance, and deductibles are due at the time of service.
• Your card may be used for any remaining balance after your insurance has processed the claim, including but not limited to:
  • Paperwork fees (e.g., letters, forms, prior authorizations)
  • Missed appointment or late cancellation fees
  • Other patient responsibility amounts

Payment Authorization Policy:

• Charges of up to $125 may be processed without prior notification.
• We will process charges over $125 only after notifying you at least 10 days in advance. We may notify you via text message, email, or voicemail.

Your Responsibility:

It is your responsibility to notify Beacon of Hope of any changes to:

• Your credit card or billing information.
• Your phone number, email address, or mailing address.
• Any contact preferences needed for timely notification.

Authorization and Consent:

I authorize Beacon of Hope to store my credit card on file securely and to charge this card for all applicable fees as outlined above, including:

• Payment for services rendered, including copays, coinsurance, deductibles, and non-covered services.
• Patient-responsibility balances up to $125 without additional notice.
• Balances over $125 only after at least 10 days' prior notification via text message, email, or voicemail

I understand that I am responsible for keeping Beacon of Hope informed of any changes to my contact or payment information to ensure proper communication and billing.