Charges and Payments Policy

(a) Clients and/or patients of Affinity Occupational Health (AOH) agree to pay for (i) all use of AOH services (including, if AOH is the party billing for third party services, such as laboratory or radiology services ordered on behalf of you or your employee, (ii) professional fees or applicable service charges, (iii) medical equipment provided by AOH or a third party on your behalf, and (iv) any applicable local, state and federal fees and taxes. All charges are set forth on a price list updated and mailed out annually, or can be provided on request. Bills are sent at the end of each month in which charges are incurred. Other charges will be billed in the next practicable monthly billing cycle following use, or as otherwise specified in the price list. AOH may change both the fees and the types of charges (e.g., periodic, time-based, use-based) for services.

(b) If your account is past due and AOH assigns a collector to your account, a collection fee may be charged. The current collection fee can be provided on request. You will also be responsible for all other expenses (including reasonable attorneys' fees and costs) incurred by AOH in collecting any amounts due under this policy and not paid.

(c) All charges are payable net 30 days from the date of invoice or as otherwise indicated on your bill.  Late charges may be assessed if your account is past due.  Failure to deliver payment by the due date is a breach of your agreement to accept services and abide by the policies and procedures of Affinity Health System. The current late fees are on the price list or can be provided upon request and, if applicable, will not exceed the maximum late fees as set forth by applicable law. AOH reserves the right to change the late fees.

(d) If your account with AOH is past due, AOH may terminate any services or accounts in accordance with applicable law. If a credit is due to you or a deposit is being held on any account with AOH, the credit or deposit may be used to offset amounts past due on any other account you may have with AOH without notice to you. To resume any terminated services, you may be required, in addition to payment of all outstanding balances on all accounts with AOH, to pay all charges at the time of service.

(e) AOH may verify your credit standing with credit reporting agencies and require a deposit based on your credit standing or other applicable criteria. AOH may require a security deposit, or a bank or credit card or account debit authorization as a condition of providing or continuing to provide services. If AOH requires a security deposit, the obligations of AOH regarding such security deposit will be governed by the terms of the deposit receipt provided by AOH to you at the time the deposit is collected. AOH may deduct amounts from your security deposit, bill any bank or credit card submitted, or utilize any other means of payment available to AOH for any past due amounts payable to AOH.

(f) AOH may charge fees for all returned checks and account debit, bank card or charge card chargebacks. The current return/chargeback fees are listed in the list of charges on the price list or can be provided on request. AOH reserves the right to change return/chargeback fees.

(g) It is your responsibility to report AOH billing errors within 30 days from receipt of the bill so that service levels and all payments can be verified. If not reported within 30 days, the errors are waived.

(h) AOH has no obligation to provide notification of, or change rates to reflect, offers it may make to other clients that contain different prices for services (e.g. packages of services).

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1506 S. Oneida St
Appleton, WI 54915
(920) 738-2000

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