Credit Card On File Policy

Credit Card on File and Automatic Billing Authorization & Agreement 

1. Credit Card Information
The Patient agrees to provide valid credit card information to Oral Maxillofacial Associates of Montclair for the purpose of billing any outstanding balances. The Patient authorizes the Provider to keep the credit card information securely on file for future charges.

2. Billing for Account Balances
The Patient agrees that any outstanding account balances for services rendered that are over 60 days past due will be automatically charged to the credit card on file, irrespective of the status of any insurance claims, including but not limited to incomplete or denied claims.

3. Payment Terms
a. The Patient acknowledges that the Provider may charge the credit card on file for any unpaid amounts once the balance is over 60 days old.
b. The Patient further acknowledges that, in the event an insurance claim is not paid or is denied, the Provider may still proceed with charging the credit card for the outstanding balance.

4. Notification of Charges
The Patient agrees to receive notifications of charges to the credit card on file, but understands that the Provider is not obligated to wait for final claim processing or resolution before charging the card for any past-due balances.

5. Updates to Credit Card Information
The Patient agrees to promptly update the Provider with any changes to credit card information. If the credit card on file becomes invalid or is declined, the Patient agrees to provide an alternative payment method within five (5) business days. Failure to provide updated information may result in further collection actions.

6. Authorization
By providing credit card details, the Patient authorizes the automatic billing of any outstanding balances that are over 60 days past due, as set forth in this agreement.