Returned Check Policy. If a payment is made on an account by check, and the check is returned as Non-Sufficient Funds (NSF), Account Closed (AC), or Refer to Maker (RTM), the patient or the Patient’s Responsible Party will be responsible for the original check amount in addition to a $35.00 service charge. Once notice is received of the returned check, this office will contact the Responsible Party of the returned check. If a response is not made within 15 days from the date of contact by the Patient or the Responsible Party, the account may be turned over to our collection agency and a collection fee will be added to the outstanding balance – in addition to the $35.00 Check Service Charge.
Appears in 2 contracts
Samples: Financial Agreement, Financial Agreement
Returned Check Policy. If a payment is made on an account by check, and the check is returned as Non-Sufficient Sufficient Funds (NSF), Account Closed (AC), or Refer to Maker (RTM), the patient Patient or the Patient’s Responsible Party will be responsible for the original check amount in addition to a $35.00 check service charge. Once notice is received of the returned check, this office Practice will contact send out a letter to notify the Responsible Party of the returned check. If a response is not made within 15 days from the letter date of contact by the Patient or the Responsible Party, the account may be turned over to our collection agency and a collection fee will be added to the outstanding balance – in addition to the $35.00 Check Service Chargecheck service charge.
Appears in 2 contracts
Samples: Patient Financial Responsibility Agreement, Patient Financial Responsibility Agreement
Returned Check Policy. If a payment is made on an account by check, and the check is returned as Non-Sufficient Sufficient Funds (NSFNFS), Account Closed (AC), ) or Refer to Maker (RTM), the patient or the Patient’s Responsible Party will be responsible for the original check amount in addition to a $35.00 25.00 service charge. Once notice is received of the returned check, this office Spring Hill Dermatology, PLC will contact the Responsible Party of the returned checksend a new statement with a new service charge. If a response is not made within 15 days from the letter date of contact by the Patient or the Responsible Party, the account may be turned over to our collection collections agency and a collection fee will be added to the outstanding balance – in addition to the $35.00 25.00 Check Service Charge.
Appears in 1 contract
Samples: Financial Policy
Returned Check Policy. If a payment is made on an account by check, and the check is returned as Non-Sufficient Sufficient Funds (NSF), Account Closed (AC), or Refer to Maker (RTM), the patient Patient or the Patient’s Responsible Party will be responsible for the original check amount in addition to a $35.00 25.00 check service charge. Once notice is received of the returned check, this office Practice will contact send out a letter to notify the Responsible Party of the returned check. If a response is not made within 15 days from the letter date of contact by the Patient or the Responsible Party, the account may be turned over to our collection agency and a collection fee will be added to the outstanding balance – in addition to the $35.00 Check Service Charge25.00 check service charge.
Appears in 1 contract