CREDIT CARD ON FILE POLICY

Alavie Interventional Pain Management is committed to providing you with exceptional patient care and we endeavor to make our own insurance billing process as simple and efficient as possible. The healthcare industry, however, is rapidly changing, which has resulted in many insurance companies transferring more costs to you. To streamline our billing and payment system and to provide you with a seamless way to pay bills, Alavie Interventional Pain Management requires that all patients maintain a credit, debit card, or HSA card on file for payment processing. This is a convenient and efficient method of payment for any costs for which you are responsible, particularly services that your insurance determine are “patient responsibility.”

We will continue to submit claims to your insurance carrier as usual. When we receive notice from your insurer, the claims will be reconciled, insurance payments posted, and your “patient responsibility” portion will be charged to your credit, debit, or HSA card on file. You will not receive a paper bill and will not need to submit payment, as it will already be covered by the credit, debit, or HSA card on file. Circumstances when your card may be charged include, but are not limited to completion of Theranow physical therapy visits, missed co-payments, deductible, and co-insurance payments, or any non-covered services and/or denial of services by your insurance company. An email receipt of the payment will be sent to you and your account balance will be zero, unless other office visits have not yet been processed by your insurance carrier. 

Your insurance company should provide you with an explanation of benefits (“EOB”) that shows what the insurance company has paid, and the outstanding patient responsibility amount owed by you. If you should disagree with a claim, it is your responsibility to contact your insurance company immediately to dispute any such amounts owed by you and/or paid on your behalf. Upon our receipt of your EOB, Alavie Interventional Pain Management shall enter all necessary information in our system and any remaining balance owed by you will be charged to the card on file, not to exceed $300, within 12 days of balance notification that you will receive via email. Should your insurance company adjust your claim and you are owed a credit, Alavie Interventional Pain Management will refund your card upon receipt of a revised EOB or other written proof issued by your insurance company reflecting such adjustment.

Your credit, debit, or HSA card information is kept confidential and secure, according to all applicable federal, state, and local laws, and regulations, including, but not limited to, credit card storage and processing laws, such as the Payment Card Industry Security Standards. Alavie Interventional Pain Management does not store your card information on site. We store it with a third-party vendor that has certified it meets the industry standards from the Payment Card Industry Security Standards (“PCI-DSS”).

If the card you have saved on file with Alavie Interventional Pain Management changes, please notify your physician’s office immediately to provide updated card information. If we run your card and it is denied for any reason, we reserve the right to charge an additional $25 declined card fee if we are not able to run a new credit, debit, or HSA card within 5 business days after a charge is declined.