Invoicing and Payment Due Date

I understand that payment is due at the time of service. An invoice is issued following the service and may be paid by direct billing (where available), by the card on file, or by another approved payment method.

Credit Card on File (Secure Tokenization)

I authorize HEH to store my payment card as a secure token with its PCI-compliant payment processor. I understand HEH staff do not store full card numbers or CVV.

If I am unable or unwilling to keep a valid card on file, I understand HEH may require an alternative payment arrangement, such as payment in full at the time of service, a PAD agreement, or another approved arrangement.

Direct Billing and Patient Responsibility

Where available, HEH may submit eligible claims to my insurer on my behalf. I understand that direct billing is not guaranteed and may not be available for all insurers, plans, services, or provider types.

I remain responsible for:

• any co-payments, deductibles, coinsurance, or non-covered amounts;
• any amount not paid by my insurer; and
• the full cost of services where direct billing is unavailable, not supported, unsuccessful, or cannot be submitted using the information provided.

What HEH May Charge to the Card on File

I authorize HEH to charge the card on file for amounts I legally owe, including:

• Amounts due after my appointment when direct billing is not available, including where no eligible direct billing coverage is available on file, the insurer or plan does not permit direct billing or assignment for the service, or the claim cannot be submitted with the information provided.
• Patient-responsibility portions after insurer processing, including co-payments, deductibles, coinsurance, non-covered services, and unpaid residual balances.
• Posted no-show and late-cancellation fees, as disclosed in the clinic’s cancellation policy.
• Past-due balances after advance notice, as described below.

Timing of Charges

Where direct billing is not available for the appointment or service, I understand HEH may charge the card on file for the amount owing after the session once the invoice is posted.

Where direct billing is submitted, I understand HEH may charge the card on file only for the portion I legally owe after insurer adjudication, unless I choose to pay by another method first.

Past-Due Balances and Advance Notice (Day 30 / Day 33)

I understand that if an invoice remains unpaid and reaches Day 30, HEH will send a 3-business-day notice stating that the card on file will be charged on or after Day 33 unless, before the charge date, I:

• pay the balance using another method,
• set up an approved payment plan, or
• notify HEH of a billing dispute for review.

Disputes and Limits on Auto-Charges

I understand HEH will not auto-charge:

• amounts that are in dispute and under review,
• amounts HEH is not legally permitted to collect, or
• balances pending insurer adjudication where a claim has already been submitted.

Receipts, Privacy, and Payment Security

I understand that receipts may be sent by email or SMS, may exclude diagnosis information, and may use generic service descriptions. Printed copies are available upon request.

I understand HEH uses approved payment processors and that staff must not write down or store full card details.

Refunds and Overpayments

I understand that overpayments will be refunded within 10 business days or may be left as a credit on my account at my request. Package refunds are proportional unless a separate signed agreement states otherwise, where lawful.

Collections and Minimum Necessary Disclosure

I understand that if a balance remains unpaid, HEH may issue a final notice around Day 45 and may refer the account to a licensed collections agency between Days 60–90. I understand HEH will disclose only the minimum necessary billing information for collections purposes, such as my contact information, invoice number, invoice amount, dates of service, and a generic description of service, and will not disclose clinical notes.

Questions or Concerns

I understand I may contact HEH Billing regarding statements or payment arrangements at info@hyperionhealth.ca or (587) 355-1723.