Credit Card On File Policy & Agreement

Behavioral Health Center has adopted a new credit card policy; effective March 3, 2023, all clients with private insurance, or who are self-pay, will be required to keep a credit, debit or HSA card on file. We understand that some clients, for legitimate reasons, may not have a credit, debit or HSA card, and in such situations payment will be expected prior to services being rendered. This policy will help to ensure that balances are paid on time and will make payment of your bill much easier. If you have checked-in to a hotel, or used a car rental service, you will be familiar with a Credit Card On File policy (CCOF).

To safeguard your card information against electronic theft or loss of data integrity, your information will not be stored electronically, but will be stored securely on-site, in accordance with our HIPAA-compliance standards. Your card’s security code will not be required or kept on file. Your card information will be used to process the cost of your session and will be processed via our HIPAA-compliant payment system. If you are a self-pay client this will be the full cost of your session. If you have private insurance our office staff will inform you of your financial responsibility before processing payment. It may be necessary that you are charged the full rate of your session until your insurance has been adjudicated, at which time you will be contacted with your updated policy rates and any credits on your account refunded.

Your card information will be processed within five (5) business days of the date of service for your session. Keeping your card information on file does not in anyway infringe upon your rights as a card holder. You may at any time dispute a charge made to your card or question your insurance company’s decisions. If you have any questions or concerns regarding this policy, please contact our office at (207) 941-0879.

Your card information will only be used for the following purposes:

·  Session payments not collected at the time of your visit

·  No-show or cancellation fees

·  Insurance discrepancies

· Any outstanding balances 31 days beyond the date of service