Patient Financial Responsibility Agreement
This agreement describes general financial responsibilities associated with services provided by NATT Weight Loss and Primary Care Services. Specific prices, insurance participation, payment arrangements, and service-specific terms may vary and should be confirmed with the practice.
Responsibility for charges
Except where prohibited by law or controlled by an applicable payer contract, the patient or responsible party is ultimately responsible for valid charges associated with services received.
Insurance information
If NATT submits claims or otherwise works with insurance, patients are responsible for providing accurate and current insurance information and promptly reporting changes. Verification of benefits or eligibility is not a guarantee of payment. Deductibles, copayments, coinsurance, exclusions, prior-authorization requirements, and coverage determinations are controlled by the applicable health plan.
Amounts not covered
Patients may be responsible for applicable deductibles, copayments, coinsurance, non-covered services, self-pay services, or amounts an insurer determines are patient responsibility, except where law or contract provides otherwise.
Self-pay and good faith estimates
Patients who are uninsured or who choose not to use insurance may have rights under federal law to receive a Good Faith Estimate of expected charges in qualifying circumstances. NATT will provide estimates and related notices as required by applicable law.
Weight-management medications
Medication cost may be separate from consultation or program fees. Insurance coverage for semaglutide, tirzepatide, or other prescribed medications varies and is not guaranteed.
Payment processing
If electronic payments are enabled, NATT may use a third-party hosted payment provider such as Stripe or Square. NATT WordPress is not intended to store full card numbers or card security codes.
Returned or failed payments
If a legitimate payment is declined, returned, reversed, or disputed, the patient remains responsible for valid outstanding amounts, subject to applicable law and payer requirements.
Cancellations and no-shows
If NATT adopts a cancellation, late-cancellation, or no-show fee, the amount and notice period should be disclosed to the patient before the fee is imposed. This website policy does not create an undisclosed fee.
Refunds
Refund eligibility depends on the services provided, applicable law, payer requirements, payment-provider rules, and NATT’s then-current written financial policies. Nothing in this agreement eliminates rights that cannot lawfully be waived.
Collections
Valid unpaid balances may be subject to reasonable collection activity as permitted by law. Where a federal patient-provider dispute process applies, NATT will comply with applicable restrictions and procedures.
Questions
NATT Weight Loss and Primary Care Services
Katy, Texas 77405
Phone: 832-771-6804
Email: info@nattww.com