I agree that it is my responsibility to maintain sufficient funds in my account until each transaction I authorize processes. I acknowledge that I am also responsible for all fees charged by my financial institution associated with the transactions authorized. If a payment is rejected due to insufficient funds, I agree that The Oregon Clinic may attempt to process the transaction again and may debit a returned item fee. I acknowledge that I will be liable for any fees, including insufficient funds or returned entry fees. I also authorize The Oregon Clinic to electronically debit or credit my account to correct any erroneous transfers.
IMPORTANT: If paying for healthcare services rendered, the following consent applies. The following does not apply to the payment of health insurance premiums.
This authorization applies separately to each of Service Provider's patient accounts billed to me and the balances that I owe under each of those patient accounts. A patient account is a financial obligation as a result of a visit to The Oregon Clinic. I understand that a Service Provider may create multiple patient accounts for me as a result of a single visit to Service Provider, and that multiple patient accounts may be listed on a single statement I receive in the mail. For example, a single radiology service visit may result in one statement mailed to me with two patient accounts against each patient account under this authorization: one charge for the facility usage and another charge for a radiologist to interpret the test.
Automatic Payments is a feature that notifies you of future balances and automatically schedules a payment for your balance up to your Automatic Payment Limit.
Q: Which payment method will be used for the scheduled payment?
A: The automatically scheduled payment will be charged to the payment method you have on file.
Q: What is an Automatic Payment Limit?
A: The Automatic Payment Limit is the maximum amount a single payment will be scheduled for. If your new balance exceeds this amount, a payment will be scheduled for the maximum amount. This limit applies to each new balance.
Q: Can I edit my Automatic Payments enrollment after I sign up?
A: Yes, you can edit the maximum payment amount, payment method, or cancel your enrollment from this portal.
Q: How will I be notified of future balances?
A: A notification will be sent with your balance, the scheduled payment amount, and the date the payment is scheduled for.