Financial Responsibility and Cancellation Policies
Appointments and No-shows
I understand that my appointment time with Aila Health is reserved exclusively for my care for the duration of all scheduled visits. I understand that I am expected to keep all appointments, as scheduled, in order to ensure maximum progress in connection with my treatment and care and that if I am late for an appointment, the visit will end at the scheduled time and I will be responsible for the cost of the full visit.
If I need to cancel or reschedule an appointment, I will cancel the appointment using the Appointments tab in the Patient Portal.
I understand that appointments must be cancelled or rescheduled at least 48 hours prior to the scheduled appointment or I will either forfeit my appointment or incur a cancellation fee. I agree that cancellation within 48 business hours of the scheduled appointment will incur a cancellation fee equal to 100% of the appointment fee. This fee cannot be filed to insurance. No-shows will be documented in the practice management system and a history of no-shows may result in refusal to schedule future appointments.
Financial Responsibility and Authorization for Payment
One important aspect of optimal patient care is to have an agreement as to financial responsibility to ensure timely payment for services. Patients or their legal representative are ultimately responsible for all charges for services rendered. Payment is charged each month for the Membership and at the time of service for all charges owed for the current visit as well as any prior balance. I understand that payment for all services, treatments, products and other fees will be required at each visit and after each other service related matter, and I authorize Aila Health to charge all outstanding balances to my credit card on file. I authorize my credit card to be used to guarantee and pay for late cancellations, missed appointments, and unpaid balances, including those related to office visits, telephone and electronic consultations, charges for products, lab tests, supplements, and other costs associated with care. I agree that if for any reason the credit card on file does not accept the charge, I will immediately make payment to Aila Health for the amount due and will provide alternative credit card information upon request. I understand that a $25.00 charge, or 3% of the total invoice, whichever is greater, will be added to my account for each credit card declination.
I understand that if I choose to pursue a chargeback through my credit card company for any charges for appointments that I have completed or other charges that I have approved, or otherwise accrue an unpaid balance, I forfeit my right to privacy and the information required to pursue collection and/or legal action will be disclosed in seeking remuneration. If I do pursue a chargeback, I understand that I will be charged a reasonable administration fee for charges associated with Aila Health disputing the action.
Insurance Responsibility and Claims Management
I understand that Aila Health does not currently participate in insurance plans or accept assignment from any other payer including employers or insurers. I will be responsible for all charges and fees incurred for treatments or services rendered, whether covered or not by my insurance company, Medicare or Medicaid, or any other health plan. I understand that insurance reimbursement may not be available for some services. By way of example, I acknowledge that I have been informed that my insurer may not pay for office visits, telephone or video consultations, or emails, including, but not limited to, circumstances where the focus of the consultation is on prevention, education, wellness, or nutrition advice. I also understand that some of the lab tests that are ordered, particularly those that are used in support of wellness consultations or are kits sent to labs using innovative approaches to diagnostics, may not be reimbursed.
Cancellation Policy for Aila Health Membership
For our members, you authorize us to charge you the Monthly Membership Fee to your chosen payment method at the time of the initial payment and each month thereafter until you cancel. You must cancel your membership before it renews to avoid being charged the monthly membership fee for the next month. You can cancel your membership at any time. If you cancel your membership and your subscription term has not expired, you may continue to use the services until the end of your membership period and your membership will not be renewed after your membership period expires. You are not eligible for a prorated refund of any portion of the monthly membership fee when you cancel.
How to Cancel Your Account
Monthly membership can be cancelled at any time. If you need to cancel, access the menu in the top left corner of the Aila Health app. Select “Subscription” and then “Manage Subscription.” You will have the option to update your billing information or cancel your plan.
Complaints, Comments and Questions
I understand that Aila Health is committed to providing quality care and resolving favorably any complaint, problem, question or unsatisfactory experience that might occur in connection with medical or nutritional services, and that it is the policy of Aila Health that if any person has a complaint or problem or unsatisfactory or negative experience related to our business, services or products, such person must bring the matter to the attention of Aila Health privately, by email (firstname.lastname@example.org) or by phone (415-480-1640) and Aila Health will investigate any such matter and attempt in good faith, without any retaliation, to reasonably resolve the matter.