At Legion Health, we are committed to providing high-quality care while maintaining transparent financial policies. This agreement outlines our financial practices to ensure mutual accountability and understanding.

Payment Policy

• Payment at Time of Service: Payment for all visit fees is required at the time of service unless alternative arrangements are confirmed in writing.

  • Insurance Responsibility: While Legion Health will assist with submitting insurance claims, it is your responsibility to:

    • Verify coverage and benefits with your insurance carrier.

    • Pay for any non-covered services, deductibles, co-payments, or co-insurances as determined by your insurer.

  • Insurance Denials: If your insurance denies a claim because:

    • We have incomplete or outdated information from you

    • You didn't inform us about changes to your insurance policy

    • Plan requirements weren't met

  • You'll be responsible for the cost of the denied services at our standard cash-pay rates.

Patient Responsibility Collection Policy

• Your patient responsibility, which includes any remaining balance not covered by your insurance, will be collected after your visit. Here's how the process works:

• We submit the claim to your insurance approximately 5 days after your visit.

  • Insurance typically processes and finalizes payment details within 7-14 days, though it may take longer in certain cases.

  • Once we receive the insurance determination, we will promptly charge your responsibility amount directly to your credit or debit card on file.

Please note that you are responsible for paying any amount not covered by your insurance. If you have questions about what your insurance will or will not cover, we encourage you to contact your insurance provider directly for clarification.

This ensures accurate billing based on your insurance's assessment. If you have any additional questions about your responsibility or the billing timeline, please feel free to contact us.

Credit Card Validation and Payment Policy

• Credit Card on File: A valid credit card is required prior to your initial appointment to:

  • Confirm authenticity via a nominal refundable charge.

  • Streamline payment for services, fees, and outstanding balances.

  • Declined Payments: If a charge is declined:

    • You will be notified and asked to provide updated payment details within 24 hours.

    • Unresolved payment issues may result in appointment cancellation.

Automatic Payments: Outstanding balances will be automatically charged to the credit card on file.

Appointment Cancellation and No-Show Policy

• Fees:

  • Initial Visit: $250

  • Follow-Up Visit: $150

• Definitions:

  • No-Show: Failure to arrive within 10 minutes of the scheduled appointment.

  • Late Cancellation: Canceling or rescheduling within 48 hours of the appointment time.

• Repeated No-Show/Late Cancellation:

• Patients who miss or cancel multiple appointments may face discharge from care: 

  • Initial Visits: Two (2) missed or late-canceled appointments. 

  • Total Appointments: Three (3) or more missed/late-canceled appointments.

Exceptions: Fees may be waived for verified emergencies (e.g., medical or family emergencies). Supporting documentation may be required

Outstanding Balances

• Automatic Collection: Any unpaid balances will be charged to the credit card on file automatically. If this charge fails, you will be notified and must resolve the balance promptly to avoid service interruptions.

  • Appointment Restrictions for Outstanding Balances: If your balance is not cleared within 24 hours of notification, future appointments may be canceled. Rescheduling will only be allowed after full payment of any outstanding amount.

  • Payment Deadline: Outstanding balances must be paid within 30 days of notification. Failure to settle the balance within this timeframe may result in discharge from Legion Health services and the balance being referred to collections as "bad debt."

Legal and Administrative Fees

• In the event of a payment default, you agree to be responsible for any finance charges, collection costs, attorney fees, and additional expenses incurred by Legion Health to recover outstanding balances.

Authorization to Release Information

• By signing below, you authorize Legion Health to release any necessary information to insurance carriers, government agencies, or other entities financially liable for your care to facilitate payment. This includes, but is not limited to, allowing representatives to examine and make copies of medical records related to treatment.

By signing this agreement, you confirm your understanding and acceptance of the financial policies of Legion Health. This agreement is binding and applies to all services rendered to you by Legion Health.