Financial Responsibility Agreement Policy
At Community Choice Home Care, we prioritize providing exceptional care services to our clients. To ensure a clear understanding of financial obligations, we have established the following policy regarding payments and responsibilities.
- Service Charges and Fees:
- Clients availing themselves of our services acknowledge and agree to pay for services rendered by the agreed-upon service plan.
- Service charges will be clearly outlined in the service agreement and may include hourly rates, specific care services, or other applicable charges.
- Billing and Payment:
- Invoices will be generated and provided on a scheduled basis, typically bi-weekly or monthly, as agreed upon in the service plan.
- Payment is due within [specify the number of days, e.g., 15 days] of the invoice date. Late payments may incur additional charges or interest as outlined in the agreement.
- Methods of Payment:
- Community Choice Home Care accepts various forms of payment, including but not limited to cash, checks, credit/debit cards, electronic funds transfer, or other agreed-upon methods.
- Payment details and preferred methods will be specified in the service agreement.
- Changes in Services:
- Any changes in the service plan, schedules, or additional services required must be communicated and agreed upon by both parties in writing to ensure accurate billing.
- Financial Responsibility:
- Clients or responsible parties (if applicable) are responsible for all charges associated with the care services provided, including any costs not covered by insurance or other third-party payers.
- Delinquent Accounts:
- In cases of delinquent accounts, where payments are not received within the stipulated period, Community Choice Home Care reserves the right to take appropriate actions, including discontinuation of services until the account is settled.
- Confidentiality:
- All financial information and records will be kept confidential and used solely for billing and administrative purposes in compliance with privacy regulations.
- Termination of Services:
- Failure to comply with the financial responsibilities outlined in this agreement may result in termination of services after appropriate notice is provided.
Acknowledgment: I acknowledge that I have read and understood the Financial Responsibility Agreement Policy of Community Choice Home Care and agree to comply with the terms and conditions outlined herein.
Client Name: _______________________
Signature: _________________________ Date: _______________
