BESA HEALTH MEMBERSHIP & CARD ON FILE POLICY
Notice to Patients: This policy outlines your membership requirements, billing rights, automatic payment schedules, and insurance balance procedures at BESA Health. Please review carefully prior to electronic signing.
1. Membership Requirements
To receive continuous care and access services at BESA Health, all patients must enroll in an active Membership Plan suitable for their coverage type and care needs. Membership tiers, features, and recurring subscription costs are disclosed prior to enrollment.
2. Access Plan Free Trial Terms
- Free Trial Period: Where applicable to selected Access Plans, enrollments include a designated free trial period (minimum of 14 days) starting on your enrollment date.
- Auto-Renewal Notice: Members on an Access Plan will receive an electronic notification (email/SMS) ten (10) days before their trial or membership auto-renewal date, detailing the upcoming renewal date and recurring fee.
- Cancellation During Trial: You may cancel your membership at any time during the trial period without incurring any subscription charges. If you do not cancel before the final trial day at 11:59 PM local time, your card on file will be charged the recurring membership fee.
3. Card on File (COF) Requirement
Unless covered under an approved fee-waiver or financial assistance program that exempts payment method collection, all members must maintain an active, valid payment card (Credit, Debit, or HSA/FSA card) linked to their account. Card details are processed through a secure, PCI-DSS compliant payment gateway and stored as encrypted tokens. BESA Health staff never store or view raw credit card numbers.
4. Automatic Payment Authorization
By electronically agreeing to this policy, you authorize BESA Health to automatically process payments using your designated card on file under the following conditions:
A. Recurring Membership Fees
Following any applicable trial period, recurring membership fees will be billed automatically on a monthly or annual basis (depending on your selected billing cycle) until you formally cancel your membership or qualify for fee adjustments under our Financial Assistance Program.
B. Post-Insurance Medical Balances
For services submitted through your health insurance provider (commercial plans, Medicare supplemental, etc.):
- Insurance Processing: BESA Health will bill your insurance provider. Your insurance will send both you and BESA Health an Explanation of Benefits (EOB) detailing approved patient responsibility (copayments, coinsurance, or deductibles).
- Itemized Statement & Pre-Notification: Before charging your card on file for any insurance balance, BESA Health will send you an itemized electronic billing statement. You will have a 3-calendar-day review window from the date of issuance to review, query, or dispute the balance.
- Automatic Charge: If no dispute, correction request, or alternative payment arrangement is submitted within 3 calendar days, the remaining balance will be charged automatically to your card on file.
- Balance Cap & Security Threshold: If your outstanding post-insurance balance exceeds $300.00, BESA Health will request explicit confirmation before processing the charge. Balances of $300.00 or less will process automatically following the 3-day review window.
- Medi-Cal Exemption: Medi-Cal recipients are strictly exempt from automatic medical balance billing for all Medi-Cal covered services.
5. Cancellation & Payment Updates
- Updating Card Details: You are responsible for keeping your payment method valid and current. You may update your payment details at any time via the patient portal or by calling billing support.
- Membership Cancellation: You may cancel your membership by giving written notice or completing the cancellation request in the patient portal. Recurring membership billing will terminate at the end of your current billing cycle.
- Unpaid Balances: Cancelling your membership does not waive accrued medical charges for care already received (except where prohibited by Medicaid/Medi-Cal rules or covered by financial assistance).
6. Financial Assistance, Medicare, & Medi-Cal Auto-Enrollment
BESA Health is dedicated to ensuring care remains equitable and accessible. We maintain a Financial Assistance Program (sliding fee discount and fee-waiver program) for eligible individuals:
- Automatic Enrollment for Medi-Cal & Medicare: Patients with verified primary coverage through Medi-Cal or Medicare are automatically enrolled into our Financial Assistance Program upon verification of benefits.
- Medi-Cal Balance Billing Protection: In accordance with California and federal regulations, Medi-Cal beneficiaries will never be balance-billed for covered medical benefits, and membership fees are waived or fully subsidized under our financial assistance guidelines.
- Medicare Compliance: For Medicare beneficiaries, financial assistance is applied to reduce or waive membership program costs in full compliance with Medicare guidelines and CMS regulations. Any billed clinical services follow standard Medicare coinsurance and deductible rules.
- General Financial Assistance: Patients without Medicare or Medi-Cal who experience financial hardship may apply for our sliding-scale financial assistance program at any time by contacting billing support.
7. Payment Authorization Summary Table
Category / Plan Type | Notice / Review Window | Payment / Billing Policy |
|---|
Access Plan Free Trial | Notice sent 10 days prior to renewal | Auto-renews unless cancelled within trial period |
Recurring Subscription | Schedule defined at enrollment | Automatic recurring charge to card on file |
Insurance Balances (≤ $300) | 3 calendar days after EOB statement | Automatic charge after 3-day review window |
Insurance Balances (> $300) | 3 calendar days after EOB statement | Explicit patient confirmation required prior to charge |
Medi-Cal Enrollees | Verified at intake | Auto-enrolled in Financial Assistance; zero balance billing for covered services |
Medicare Enrollees | Verified at intake | Auto-enrolled in Financial Assistance for membership; CMS standard billing rules apply |
8. Electronic Signature & Consent Disclosure (ESIGN & UETA Compliance)
Under the federal Electronic Signatures in Global and National Commerce Act (ESIGN) and the California Uniform Electronic Transactions Act (UETA):
- Consent to Electronic Records: By checking the agreement box or providing your typed/drawn signature electronically, you explicitly consent to conduct billing transactions electronically and acknowledge that your electronic signature holds the exact same legal validity, effect, and enforceability as a physical pen-and-paper signature.
- Right to a Paper Copy: You have the right to receive a physical paper copy of this authorization upon request by contacting BESA Health Billing at no additional charge.
- System / Hardware Requirements: To access and retain this electronic agreement, you must have access to a web browser, internet connection, and software capable of viewing standard web documents and PDFs.
- Revocation of Electronic Consent: You may withdraw your consent to receive future notices electronically by notifying BESA Health in writing; doing so does not affect prior authorizations or valid transactions executed before receipt of the withdrawal.