Financial Understanding
I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment regardless of any claim or coverage or any other party that I feel may be responsible for payment.
I understand and agree that health/accident and insurance policies are an arrangement between an insurance carrier and myself; and that it is through the good will of this office that a superbill may be given me for potential 3rd party reimbursement. I also understand that even if billing and/or assignement of benefits is done on my behalf that this does not consitute an agreement between Dr. Louis Abate/Illuminare Wellness and any insurance company or 3rd party reimburser.
I agree that Dr. Louis Abate/Illuminare Wellness/employees will only provide a superbill for my reimbursement once. If payment is denied for any reason I agree to actively take part in collecting payment from the 3rd party AND I agree that and and all open balances on my account with Dr. Abate and Illuminare Wellness are my responsibility for timely payment.
I also agree to have an active credit card number, expiry date, securty code and billing address held in my file indefinitely and that credit-card-on-file may be used to clear any open balance more than 30 days past due. I agree that if this credit card on file is used to clear my open balance I will be assessed a 3.5% credit card processing fee that is in addition to any other fees associated with the collection of my balance due.
I understand that if I discontinue care, suspend or are dismissed from care for any reason all balances will become immediately due and payable in full by ME, regardless of any claim submitted. If the balance is not paid within 30 days I understand Dr. Abate will apply interest at 2% per month of open balance, will use the credit card I have placed on file and assess and additonal 3.5% credit card processing fee in addition to any other fees associated with the collection of my balance due.
I understand and agree that should my open balance be placed into court and/or collection proceedings that I will be immediately and fully responsible for the entire balance due this office (any discounted fees will no longer apply and my account will be adjusted accordingly), I am also responsible for all fees associated with the collection attempts and that collection proceedings may affect my credit score.