Financial Policy & Fee Agreement: Definition, Template & Example

Not for in-network care. When a payer processes a claim, each unpaid amount carries a group code: CO, contractual obligation, means the balance is your write-off under the network contract and cannot be billed to the client no matter what they signed, while PR, patient responsibility, marks the copays, coinsurance, and deductible amounts that can. A financial policy that promises otherwise is unenforceable on that point and can put you in breach of the payer contract. Medicaid is stricter still: providers must accept the plan payment plus allowed cost-sharing as payment in full.

Usually, with three conditions. First, the fee must be disclosed and agreed in advance, which is this document's job. Second, bill the client directly, never the plan: a missed appointment is not a covered service, and a claim for one is denied (Medicare uses code 204). Third, Medicare permits missed-appointment charges only when the same policy applies equally to all clients, so a single commercial contract that prohibits no-show fees breaks the uniformity Medicare requires; check your contracts before charging Medicare beneficiaries. Medicaid members generally cannot be charged no-show fees at all. The session-level documentation behind billed services lives in a claim-support billing note; the no-show fee never appears on a claim.

Yes to both, with disclosure doing the heavy lifting. Interest on overdue balances is lawful when the agreement discloses the rate in advance and the rate respects state usury limits; ethics codes add that clients get notice before enforcement begins. Payment plans have a federal wrinkle: a written plan payable in more than four installments, or any plan with a finance charge, makes the practice a creditor under the Truth in Lending Act, with Regulation Z disclosure duties. The safe pattern is up to four installments with no added charge, in writing, dated.

Ethics first: give written notice and a genuine chance to pay or arrange a plan before any account is referred, and use a collector bound by the FDCPA. Credit reporting has shifted under practices' feet: the national bureaus stopped reporting paid medical collections and those under $500 across 2022 and 2023, and the CFPB rule that would have removed most medical debt from credit reports, finalized in January 2025, was vacated by a federal court on July 11, 2025, in a ruling that also read the FCRA as preempting similar state bans. The practical takeaway for your policy: promise notice and process, not specific credit consequences, because that landscape keeps moving.

For self-pay clients with no federal payer in the picture, a sliding scale is private pricing and entirely yours to set. The risk zone is federal cost-sharing: routinely or promotionally waiving Medicare or Medicaid copays and deductibles can implicate the Anti-Kickback Statute and civil monetary penalty rules under a fraud alert the OIG has kept in force since 1991. The protected path is narrow and practical: no advertising, no routine waiver, and a documented, individualized determination of financial need behind each discount. Put that process in the agreement and then follow it.

Three documents, three jobs, one intake packet. The financial policy is a two-way signed contract covering all money terms of the relationship. The good faith estimate is a one-way federal disclosure for uninsured and self-pay clients, required since January 2022, that itemizes expected charges and states on its face it is not a contract; it triggers dispute rights if billing runs $400 or more past it. Informed consent covers the nature, risks, and course of therapy; ethics codes fold fees into consent, but a consent form is not a fee contract. Present all three at the first visit, then document the clinical side in the intake note.

The signature stays conventional in both countries, and the rules around it differ sharply from the US. In Canada, college standards require agreement on fees and billing before services start, and Ontario's standards have long allowed interest on overdue accounts only if the client was told at the outset; since June 20, 2024, qualifying psychotherapy and counselling therapy services are exempt from GST/HST, which changes what a compliant receipt says, and records are commonly kept 10 years, longer for minors. In Australia, bulk billing means accepting the Medicare benefit as full payment, so no gap can be charged on a bulk-billed session; standard-form cancellation clauses have been exposed to unfair-contract-term penalties since November 2023, even where the clause is transparent; and NDIS providers can claim short-notice cancellations only where the service agreement allows it, inside the scheme's notice windows. Records commonly run 7 years, or to age 25 for minors.

Yes. Give it your fee schedule, cancellation window, payer mix, and state, and it drafts the agreement in plain language, then checks the result for the classic traps: balance-billing language a payer contract forbids, a no-show clause that is not uniform, interest that was never disclosed, and installment plans that cross the four-payment line. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.