Ong Institute Payment Policy Fees

1. General Payment Policy:

• All payments must be received prior to providing services.

• All estimates are valid for 30 days unless stated otherwise.

• A 10% administration charge applies to all refunds requested after a transaction has been processed.

• You are responsible for the full payment of all fees regardless of whether you selected the pay-in-full or payment plan option.

• If special pricing is offered, only one discount can be applied per transaction and cannot be combined.

• Payment plans are available and must be arranged prior to the start of the program. Full details and terms will be provided. You are responsible for the full payment of all fees regardless of whether you choose to complete the treatment plan or program.

• We retain the right to modify our payment policies at any time.

2. Patients with Insurance:

• Insurance cards must be presented at check-in. Ong Institute does not accept insurance plans for currently offered treatments and services. Patients may use their insurance plan for prescriptions or lab fees and are responsible for direct payment to the third-party vendor providing the service. Your health insurance is a contract between you and your insurance company.

3. Professional Fees:

• Appointments canceled or rescheduled within 72 hours and all no-show appointments will be charged a $300 fee. Please provide a minimum of 72-hour notice by telephone (not email) for cancellations.

• Professional fees for lab orders are charged at the time of requesting the lab order. Once processed, this fee is non-refundable, regardless of whether you decide to proceed with the laboratory tests.

• Health Coaching Program Fees:  Full payment is required before the treatment plan starts. You are responsible for the full payment of all fees regardless of whether you choose to complete the treatment plan or program. In addition, you acknowledge that your results cannot be guaranteed, and depend largely on your commitment to the program.

• Annual Program Fees: Full payment is required before the treatment plan starts. Payments can be made by check or wire transfer. Please inquire for wire transfer details. Once the program has started, no refunds or chargebacks are allowed. In addition, you acknowledge that your results cannot be guaranteed, and depend largely on your commitment to the program.

4. Vendor Fees:

• Any services provided by a third-party vendor will be the responsibility of the patient. Ong Institute can facilitate payment of these fees and offer special pricing if available through previous agreements with vendors. These may include, but are not limited to fees for laboratory tests, ultrasound IV services, hospital fees, and other services.

5. Treatment Fees:

• Appointments canceled or rescheduled within 72 hours and all no-show appointments will be charged a $300 fee. Please provide a minimum of 72-hour notice by telephone (not email) for cancellations.

• Pre-purchased treatment series must be utilized within one (1) calendar year of the purchase date and have no cash value once the treatment plan has started or the date of validity has passed. The dollar amount of your purchase cannot be exchanged for other procedures or products.

6. Surgery Fees:

• Appointments canceled or rescheduled after the pre-operative appointment has been completed or within one (1) week of the surgical date (whichever comes first) will result in the entire paid fee being forfeited.

• In the event the surgery is rescheduled or canceled within the window above, the amount transacted must be utilized within one (1) calendar year of the purchase date, or the total amount is forfeited.

• All female patients are required to have a urine pregnancy test performed on the day of surgery. In the event of pregnancy, our policy still applies.

• Additional laboratory tests, products, or doctor visits may be required depending on your age, procedure, and medical history to ensure you are in good health for elective surgery. These may incur additional costs which you will be financially responsible for.

7. Facility Fees:

• The Ong Institute may charge a facility fee for procedures performed in the office.

• For procedures or surgeries done at a surgery center or hospital: Fees for the operating room, additional hospital charges, anesthesiologist, and other providers such as surgical assistants or additional consultants are estimates of expenses payable to outside providers. We also cannot guarantee these prices will not change. Operating room and anesthesia expenses are based on the amount of time scheduled for surgery. If additional time and/or services such as pathology, labs, hospital charges, or additional consultants are required, additional fees may result.

• If tissue samples or specimens are removed during your procedure, they will be sent to the pathologist for review, which will result in additional charges that you will be responsible to pay. In many cases, insurance providers may not cover these additional costs when done in relation to aesthetic procedures.

• It is important that you understand the patient is responsible for all costs associated with all secondary procedures or for the treatment of any complications that may arise as a result of this elective procedure.

8. Returned Checks:

• A $25 charge will be assessed for non-sufficient funds.

9. Forms Completion/Medical Records:

• Charges may apply for forms, letters, or copies of medical records. There will be no charge for medical records sent to any physician for continuing care, but a signed medical records release form is required.

• Patients requesting copies of their medical records for personal use may be charged. All patients will be required to sign a medical records release before any information can be given to them.

10. Patient Responsibility:

• Patients must inform our office of any changes to their address, phone number, insurance plan, payor, or coverage.

11. Statement of Financial Responsibility:

• Payment for all treatments and professional fees is solely the responsibility of the patient or their guarantor. As a courtesy, Ong Institute will bill your insurance if applicable.

• You authorize Ong Institute to bill your insurance company or other third parties responsible for your medical charge, if applicable, and to release any protected health information that may be requested by your insurance company to help with the process of your claims. You authorize and request payment be made directly to Ong Institute for all medical and surgical services. You understand that you are responsible for any balance not covered by your insurance company.

• If you choose to finance your payment through a third-party company, any agreements made are solely between you and that company.

12. Acknowledgment:

• By reading this, you certify that you have read or had read to you the Payment Policy Fees. You attest that you have had the opportunity to ask questions and that all of your questions have been answered to your satisfaction.