Credit Card & Co-Pay Policy

[Updated: April 17, 2025]

At Forked River Chiropractic Center, we are committed to providing transparent and efficient billing practices for all of our patients. Please review the following policy regarding credit card payments and insurance co-pays:

Credit Card on File

For your convenience and to streamline our billing process, we may request that a valid credit card be securely kept on file. This card may be used for:

  • Insurance co-pays
  • Non-covered services
  • Deductibles or coinsurance balances
  • Missed appointment or late cancellation fees, if applicable

Your card information will be stored securely using industry-standard encryption through our HIPAA-compliant payment processor. You will be notified in advance of any charges that will be applied.

Co-Payments

Insurance co-pays are due at the time of service, as required by your insurance provider. Failure to pay your co-pay at the time of your appointment may result in the rescheduling of your visit or the assessment of a billing fee.

We accept Visa, MasterCard, American Express, Discover, HSA/FSA cards, and debit cards. Post-dated checks are not accepted. Any outstanding balance not paid within 30 days may be subject to late fees or forwarded to collections.

Patient Responsibility for Non-Covered Services

By receiving services at Forked River Chiropractic Center, you acknowledge and accept that you are financially responsible for all fees not covered by your provided insurance plan. This includes, but is not limited to:

  • Services denied by your insurance carrier
  • Services determined to be non-covered or out-of-network
  • Charges applied to your deductible or coinsurance

Cash Payments

By receiving services at Forked River Chiropractic Center, you acknowledge and accept that you are financially responsible for all fees not covered by your provided insurance plan. This includes, but is not limited to:

Patients who do not have insurance or choose not to use insurance are welcome at Forked River Chiropractic Center and are considered self-pay. As a cash patient, you agree to the following terms:

  • Payment is due in full at the time of service
  • We offer transparent, upfront pricing for all services. Please ask for a fee schedule if needed.
  • We accept cash, credit/debit cards, and HSA/FSA cards.
  • No claims will be submitted to insurance on your behalf.

Contacting Us

We value your opinions. If you have comments or questions about our Credit Card & Co-Pay policy, please send them to policy@frccnj.com.

Forked River Chiropractic Center
900 Newark Ave, Forked River, NJ 08731
Phone: (609-604-6005)

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