Credit Card on File Agreement - Effective June 17,2021
Nutri- Wellness LLC has implemented a new credit card policy. Recent changes in health markets and payment processes have altered insurance coverages to shift the cost of care to our patients.
The credit card on file policy is a convenient method to pay for the portion of services that are deemed the patient’s responsibility, such as copay, deductible, and coinsurance.
The credit card information will be obtained at your initial visit and kept confidential and secure until the insurance(s) has paid their portion. If your medical insurance does not cover your nutrition consultation, then Nutri-Wellness LLC automatically charges your debit/credit card. Also, if the patient did not follow the 48 hours cancellation appointment policy, Nutri-Wellness LLC will charge $50.00 for the missed appointment. Invoice for outstanding balance will be sent to the patient via email or mail letter.
***** I authorize Nutri-Wellness LLC to keep my debit/credit card on file and to charge my debit/credit card for any outstanding balances that my health plan has identified as my financial responsibility.
If the provided debit/credit card has changed, expired, or denied for any reason, I agree to immediately give Nutri-Wellness LLC, valid debit/credit card, which I will allow to be charged over the phone. I agree that the new card will be used with the same authorization as the original card I presented.
