Credit Card on File Authorization

As insurance is not a guarantee of payment, a credit card must be kept on file as a convenient method to pay for additional amounts due per your insurance, non-covered services and no show/late cancellation fees. Your card information will be held securely in our system in an encrypted digital security vault.

After your insurance remits payment and/or an Explanation of Benefits (EOB) we will notify you of your balance through the patient portal and/or mailed statement. You will have until the 21st day after the notification is sent to manually make a payment, otherwise, balances up to $200 will be automatically drafted from your card on file. You will be required to make a manual payment for any amounts remaining after the initial $200 is drafted. No show/Late Cancellation fees are automatically debited as they occur as fol.


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