Dear Patient:

As you know, if you have ever checked into a hotel or rented a car, the first thing you are asked for is a credit card which is kept on file and later used to pay your bill.  This is an advantage for both you and the hotel or rental company since it makes checkout easier, faster and more efficient.

We are implementing a similar policy beginning July 16, 2012.  You will be asked for a credit card number at the time you make an appointment and the information will be held securely for future payments.  In lieu of a credit card, please provide us with your bank routing number and checking account number and we will debit the funds directly from your checking account when payment is due.  If you prefer to continue receiving statements, we will bill you $5.00 per statement plus a $25.00 late fee for any balance over 15 days old.

For our medical patients, we will collect your co-pay as usual, file your insurance and wait until they have paid their portion of the claim.  If your insurance company determines that you are responsible for any additional balance, it will be charged to your credit card or checking account, and a copy of the fees and payment will be e-mailed to you. You will receive an explanation of benefits from your insurance company summarizing your fees and indicating the amount owed to the provider that we will charge to your account.  Conversely, if we over collected for your service, we will immediately refund the overpaid amount to your account.

This in no way will compromise your ability to dispute a charge or question your insurance company’s determination of payment.  If you dispute or appeal any payments made by your insurance company and win the appeal, you will be refunded the additional payment.

For our cosmetic clients, your payment information will be kept on file for all payments including deposits, package purchases and product purchases.We will continue to accept cash if this is your preferred method of payment.

This will be an advantage to you since you will no longer have to write out and mail us a check or your credit card information.  It will be an advantage to us in our efforts to go paperless since it will greatly decrease the number of statements that we have to generate and send out.  The combination will benefit everybody in helping to keep the cost of health care down.

Please ask if you have any questions regarding this new payment method.

Sincerely,

Charlotte Skin & Laser

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