💳 FINANCIAL TERMS & CONDITIONS
(For Online Appointment Booking)
Effective Date: 01/01/2026
By scheduling an appointment online with Oly Heart & Vascular Institute, you agree to the following financial terms:
1. Insurance
- We accept most major insurance plans.
- It is your responsibility to verify coverage prior to your appointment.
- You must present valid insurance information at check-in.
- Co-pays, deductibles, and co-insurance are due at time of service.
2. Self-Pay Patients
- Payment is due at the time of service.
- We accept cash, credit/debit cards, and approved financing options.
- A self-pay estimate can be provided upon request.
3. Authorization & Assignment of Benefits
By booking online, you:
- Authorize us to bill your insurance directly.
- Assign insurance benefits to the clinic.
- Authorize release of medical information necessary for claim processing.
4. Cancellation & No-Show Policy
- 24-hour notice required for cancellations.
- Late cancellations or no-shows may incur a fee of $[Amount].
- Repeated missed appointments may require prepayment for future visits.
5. Outstanding Balances
- Statements are issued monthly.
- Payment is due within 30 days.
- Unpaid balances may be sent to collections.
6. Returned Payments
A $25 fee will apply to returned checks or failed electronic payments.
7. Online Payments
Online payments are processed through secure, encrypted systems. We do not store credit card information on our website servers.
8. Agreement
By completing the online appointment booking, you acknowledge that you:
☐ Have read and understand the HIPAA Privacy Policy
☐ Agree to the Financial Terms & Conditions
☐ Consent to electronic communications (email/text reminders)
Electronic acceptance constitutes a legally binding agreement.
