Financial Policy and Responsibility | Honey Bee Health Collective

We are committed to providing you with the best and affordable services. Your clear understanding of our Financial Policy is important to our professional relationship. We will gladly discuss our professional fees with you at any time and financial options.

Please note that Honey Bee Health Collective is a private pay only practice at this time and does not directly accept insurance (with the exception of Medicaid). We will however provide documentation when requested for reimbursement by your insurance. Clients are responsible for confirming insurance coverage and handling all reimbursement. Please note that all insurance companies vary and the offered services may or may not be a covered benefit by your insurance.

Payment

Payment is expected at the time of service. If payment is not received by day of service your will be charged our full rate and must be paid prior to the next scheduled session. Should payment for services rendered become a financial burden contact us to establish a payment plan. Statements are sent out every 30 days. All accounts that are 120 days past due are automatically sent to collections on day 120. You can request a statement at any time.

Financial Responsible Party:

The financial responsible party is responsible for any and all charges incurred. This may include but not be limited to: current private pay rate, no show charges, additional services, etc.

Is the financial responsible party the same as the primary legal party listed above?

Yes No

Financial statements/invoices/receipts

I authorize the indicated responsible party to receive financial statements/ invoices/ receipts via: (fill out one below)

Email Standard Mail

Email Address

Address

Address Line 1

Address Line 2

City

State

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I hereby agree to accept full responsibility for all fees for services rendered by Honey Bee Health Collective

Signature Field

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