Online Onetime Payment

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Bridgeway Recovery Center is committed to providing you with clear and transparent information about your financial obligations for the medical services we offer. These policies apply to all services you receive from us.

Co-Pays: We require payment of co-pays at the time of service and reserve the right to refuse treatment.

No Insurance: If you do not have no insurance, we collect $_____ for your initial office visit, $ _____ on your next attendance. (Note: there may be additional charges to your office visit if injections or individual therapy is required.) If your deductible has not been met yet, we will contact you to arrange payment in full or to set up a payment plan. 

Payments:  We accept cash, Visa, MasterCard, Discover and Care Credit. We also accept payment by check and debit cards. We hold a credit card number on file to reserve payment arrangement terms Bridgeway Recovery Center will send patients accounts to collections for balances not paid after receipt of two statements unless you make payment arrangements with our billing office. We reserve the right to require payment for services to be made at or before the time of service. 

Outstanding balances: Our policy is to decline appointments for patients who owe more than $250 and are not paying regularly. If you do not pay your balance by the end of a billing cycle, we will charge you a $5 late fee. When you make a payment, we will first deduct the late fee and then the remaining amount will go towards your balance. If we have to send your account to a collection agency, you will have to pay an extra fee, as well as any legal costs that may arise from recovering your debt. If you write a bad check, we will add a $30 fee to your balance.

Insurance Claim: As a courtesy, we file your claim with your insurance company on your behalf. However, you are still responsible for the payment. We do not get involved in disputes over insurance benefits. We comply with all federal, state and other contractual requirements when we bill insurance, as long as we have an agreement or we are a participating provider. If your insurance company takes more than 60 days to process your claim, we expect you to pay the full amount. You also agree to pay any charges that are not covered by your insurance. If your insurance company sends payments to you directly, please forward or drop them off at Bridgeway Recovery Center, and we will credit them to your account.

Preauthorization: Before you receive any service, you may need to get preauthorization from your insurance company. This means that they agree to cover the cost of the service. If you do not get preauthorization, your insurance company may deny your claim and not pay for the service. You will have to pay for any service that your insurance company does not cover because of this reason.

Dependents: You are responsible for payment of services rendered to your dependent if previous arrangements have been made stating such. In cases where a written court order allows payment for medical costs associated with a dependent, it is your responsibility to obtain reimbursement from the other party involved. 

Referrals: If you see a doctor that is out of network or if you use an insurance company that requires a referral, you are responsible for obtaining it from your primary care clinic or physician. Failure to obtain it may result in a lower payment or no payment from the insurance company or no benefits from your insurance company and you will be responsible for payment. 

I authorize Bridgeway Recovery Center to keep my signature on file and to charge my credit card (held in our secure system) for:  

_______________________________

Charges associated with payment arrangements.  

Contact billing office to make payment arrangements. 

Attestation Statement: 

I have read, understand, and agree to the above Bridgeway Recovery Center Payment Policy. 

I understand that charges not covered by my insurance company, as well as applicable copayments and deductibles, are my responsibility. I acknowledge that these policies do not obligate Bridgeway Recovery Center to extend credit. 

I authorize my insurance benefits be paid directly to Bridgeway Recovery Center. 

I authorize Bridgeway Recovery Center to release pertinent medical information to my insurance company when requested, or to facilitate payment of a claim.