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Brentwood Skin Clinic: Credit Card On File Policy

1. Brentwood Skin Clinic requires keeping a credit or debit card on file for billing balances not covered by insurance and for missed appointments. 2. Credit card information will not be shared or kept on file in written form, and only the last four digits will be accessible to staff. The card will be securely stored in their system. 3. They will only charge the card for uncovered balances after two statements or missed appointments without 24 hour notice, and will notify patients before billing for balances over $200. Any mistakes will be refunded within 7 days.
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0% found this document useful (0 votes)
82 views2 pages

Brentwood Skin Clinic: Credit Card On File Policy

1. Brentwood Skin Clinic requires keeping a credit or debit card on file for billing balances not covered by insurance and for missed appointments. 2. Credit card information will not be shared or kept on file in written form, and only the last four digits will be accessible to staff. The card will be securely stored in their system. 3. They will only charge the card for uncovered balances after two statements or missed appointments without 24 hour notice, and will notify patients before billing for balances over $200. Any mistakes will be refunded within 7 days.
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© © All Rights Reserved
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BRENTWOOD SKIN CLINIC

CREDIT CARD ON FILE POLICY

At Brentwood Skin Clinic we require keeping your credit or debit card on file as a convenient
method of payment in two situations:

1) We will bill your credit card for the portion of services that your insurance doesn’t
cover, but for which you are responsible. We will automatically run this charge if
payment has not been received after sending two statements. If your balance is over
$200, we will notify you before billing your card.
2) We will bill your credit card for a missed appointment if we are not notified within
24 hours of your appointment. The charges are $15 for a missed office visit and $50
for a missed surgery appointment.

We want to assure you that your credit card information is secure and it will NEVER be
shared with anyone. Our staff will NOT keep any written record of your CC information and
once entered into our secure system the only information we will have access to are the last
four digits of the card.

CREDIT CARD ON FILE FREQUENTLY ASKED QUESTIONS:

1. What if I don’t have OR don’t want you to keep a CC on file?


 We strongly encourage this as we feel this will streamline the billing and payment
process for ALL patients and therefore will lower overall costs.
 We do understand that some patients may not have a CC and we will work with each
person to come up with a plan for payments. If you feel there are questions about
security etc., we encourage you to discuss this with our staff or Dr. Mitchell. We want
this to be an easy transition.

2. When will you process my credit card?


 We will ONLY process your CC after your insurance has responded and we’ve posted
ALL payments.
 We will process your credit card if you have a balance of less than $200 after two
statements.
 We will notify you BEFORE we process your CC if you have a balance of more than
$200 and you have not paid after two statements

3. What if you make a mistake and you charge my CC incorrectly?


 If we make a mistake we will issue a refund within 7 business days of being made
aware of the mistake.

4. Are there any other situations or charges when my CC on file can be processed?
 Per our Missed Appointment Policy, we will charge your CC on file $15 for missed
office visit and $50 for missed surgery appointments IF we have not received 24 hour
notification to cancel or re-schedule.

5. What about the Security of the CC on File?


 We will ONLY write done the last four digits of your CC information and will NEVER
keep a written copy of the Full CC number.
 We will only enter in your CC information manually into our secure system when you
are present in our office at the time of service and will never make a copy of your
card.
 We use Stripe as our CC processing company and they come with one of the most
secure platforms in the industry (www.stripe.com).
 We contract with Stripe to process and store your CC information. Stripe has been
audited by a PCI-certified auditor and is certified to PCI Service Provider Level 1. This
is the most stringent level of certification available in the payments industry. To
accomplish this, we make use of best-in-class security tools and practices to maintain
a high level of security at Stripe. All card numbers are encrypted on disk with AES-
256. Decryption keys are stored on separate machines. None of Stripe’s internal
servers and daemons are able to obtain plaintext card numbers; instead, they can just
request that cards be sent to a service provider on a static whitelist. Stripe’s
infrastructure for storing, decrypting, and transmitting card numbers runs in separate
hosting infrastructure, and doesn’t share any credentials with Stripe’s primary
services (API, website, etc.).

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