Credit Card On File and Financial Responsibility Policy

Last modified: February 2025

LifeStance Health has implemented a policy where most patients are required to have a payment method registered in advance, referred to as “Card on File.” This policy is designed to streamline billing processes, save the company and patient time and hassle, and ensure prompt payment for services. Therefore, it’s important to note that LifeStance Health does not accept cash payments unless required by law.

Credit Card options may include:

• Health Savings Account (HSA)
• Health Reimbursement Account (HRA)
• Flexible Spending Account (FSA)
• Debit Card
• Credit Card

There are exceptions to our policy which may include patients with Medicare, Medicaid, or combined coverage.

LifeStance Health assures its patients that all payment card details are stored securely. The information is maintained on a protected, encrypted platform. We run our payments through our HIPAA-compliant, secure practice management software Phreesia or our electronic health records system. LifeStance Health uses a third-party service that facilitates in-person and online payment transactions and that LifeStance Health will not directly keep the credit card information within its systems. Consequently, no financial data is accessible to the staff, nor is it stored in the clinic’s systems or on its premises.

Co-pays, where applicable, will continue to be collected at each visit. LifeStance Health will process all insurance claims as per usual procedures. Once the insurance company has processed a claim, the patient will receive an Explanation of Benefits (EOB) detailing their financial responsibility for the services received. LifeStance Health will also obtain a copy of the EOB. Patients typically receive the EOB before we do, so if there is a disagreement with the patient responsibility amount owed, it is the Patient’s responsibility to contact their insurance carrier immediately. If the EOB indicates a balance owed by the patient, the registered card will be charged within a reasonable timeframe after receiving the EOB. If the EOB shows no balance due, the card on file will not be charged.

Authorization to Bill Credit Card on File. By putting a credit card on file, the patient authorizes LifeStance Health to charge the credit/debit card provided (the “Card”) for all outstanding balances, including but not limited to, co-payment and co-insurance amounts, self-pay fee schedule amounts, no-show/cancellation fees, other administrative fees, and any balance remaining after insurance reimbursement relating to services provided to the patient. Patients understand that if a payment is declined, LifeStance Health may decline to provide new services until payment or new credit card is received. By providing a credit card, the patient certifies that they are an authorized signer for the Card with all necessary rights to authorize the charges. Per the Patient Services Agreement, that each patient agrees to, THE CARDHOLDER NAMED ON THE CREDIT CARD ON FILE WITH US IS ULTIMATELY RESPONSIBLE FOR THE PAYMENT OF ANY OUTSTANDING BALANCE ON THE ACCOUNT.

Patients that have a credit card on file that expires or otherwise becomes uncollectable, LifeStance Health expects the patient promptly provide a new means of payment. Credits on the account after the patient’s insurance claim has been adjusted may be returned to the credit card on file or with a refund check. Ultimately, patients are responsible for knowing what services are covered, how often, and how much of the cost is their responsibility. Patients will be responsible for any portion of services that their insurance does not cover. To avoid any issues of discrimination or favoritism, all patients will be required to have a credit card on file regardless of insurance or visit type.

Primary Payment Responsibility. Patients agree to pay LifeStance Health for all charges incurred for services LifeStance Health rendered and assign to LifeStance Health any monies due and owing under their health insurance plan or other third-party payor, including government payors, worker’s compensation payors, personal injury case defendants, and medical benefits accident insurance payors. Patients are informed and agree that LifeStance Health may amend the fee schedule and its Terms of Service from time to time in its sole and absolute discretion and without prior notice but understand it will be available on the company’s webpage or upon request.

Patient Responsibility and Commitment, Cancellations and Missed Appointments. Patients understand that it is their responsibility to ensure their health plan benefits can be used for LifeStance Health services. To verify, please call the number on the back of their current insurance card. All LifeStance Health invoices for services and costs are due upon receipt, and all copay, coinsurance, and deductible amounts are due at the time service is delivered or post claims adjudication.

Patients understand that it is important to show up for their appointments with their treating clinicians, and to show up on time. A minimum of two (2) business days’ notice is required to avoid any fees for cancelled and missed appointments. If this notice is not received or if the patient fails to show for the appointment within the first fifteen (15) minutes of a scheduled therapy appointment or five (5) minutes of a scheduled medication appointment, the Patient agree to be personally responsible for payment for the full amount for the time reserved for the appointment. Patients agree to and understand their obligation to pay the Late Cancellation/No Show Appointment fee stated in the State-Specific Addendum to their Patient Services Agreement. Patients have agreed to grant LifeStance Health the right to charge their credit card on file for that fee if applicable.

Patients understand that health insurance does not pay for fees incurred for missed appointments. If unforeseen situations beyond their control arise, such as illness, bereavement, and accidents, etc., the patient has agreed to promptly provide LifeStance Health with documentation of same to avoid being billed for the full amount of the fee.

Third-Party Payors. Patients understand they are responsible for all monies due and owing for services rendered by LifeStance Health that are not paid by a third-party payor. It is ultimately the patient’s responsibility to ensure that any third-party payor covers, and makes timely payment for, LifeStance Health’s services. If any monies received by LifeStance Health from a third-party payor are later recouped from LifeStance Health any time after their receipt, the patient agrees to be responsible for those monies recouped. Patients agree to grant LifeStance Health the right to charge their credit card on file for all requested services or tests: (i) at the time of service; (ii) upon notice from a third-party payor that any full or partial charges are not covered by the third-party payor and/or (iii) if any previously paid amounts are recouped by the third-party payor.

Self-Pay Only with Health Insurance Coverage. Patients may have health insurance coverage that may cover some or all the services provided by LifeStance Health, but a patient may choose to self-pay and not use insurance to cover any LifeStance Health services, Patients who choose this understand that they will be fully responsible for payment of all services at the time of service. These patients have granted LifeStance Health the right to charge their credit card on file for all requested services or tests. By choosing this self-pay only option, Patient hereby agrees to not submit claims for LifeStance Health services to their health plan for reimbursement and understand that any payments made to LifeStance Health will not be credited toward satisfying any deductible or cost-sharing obligations the patient may have under their health insurance plan.  Patients with Medicare or Medicaid will not be permitted to opt to be self-pay patients due to payer rules.

Self-Pay Combined with In-Network Health Insurance Coverage. Patients understand that if their LifeStance Health provider is an in-network provider for their health insurance plan, LifeStance Health will not bill the patient directly for any services that are otherwise covered by their health insurance plan. Patient is instructed to certify that they have verified that any self-pay services they request of their LifeStance Health clinician are not covered services under their health plan. For any services or tests that are not covered by their health insurance plan, the patient grants LifeStance Health the right to charge their credit card on file for all requested services or tests at the time-of-service or upon insurance denial of coverage. For cost sharing, the right to charge the patient’s credit card on file for all requested services or tests at the time of service delivery or upon notice from the health insurance company that any LifeStance Health charges are the patient’s responsibility.

Self-Pay and No Health Insurance. If a Patient does not have health insurance or qualify for government payor benefits for LifeStance Health services, the patient agrees that they will be fully responsible for payment of all services at the time of service. The patient grants LifeStance Health the right to charge their credit card on file for all requested services or tests. Patients understand and agree that being a Medicare beneficiary disqualifies them from being a self-pay patient for LifeStance Health services unless their provider has opted out of participation and the patient signs an annual private-pay services agreement. 

Right to a Good Faith Estimate. Patients understand and agree to pay for LifeStance Health services if they are not enrolled in a health benefits plan or choose to not use their health benefits. Patients have been informed of the right to receive a Good Faith Estimate for the total expected cost of services. A Good Faith Estimate is available by calling your LifeStance Health’s Clinic. Patients agree that if they receive a bill from LifeStance Health that is at least $400 more than the Good Faith Estimate, I can dispute the bill by calling the LifeStance Health’s Billing Office. For questions or more information about patient’s rights to a Good Faith Estimate, please visit www.cms.gov/nosurprises or call 844-256-9902.

Off-Label Treatments and Tests. Many clinically appropriate medications, assessments or treatments are not currently FDA-approved or are considered experimental by third-party payors and may not be reimbursable from third-party sources. Patients consenting to these services, understand and agree that LifeStance Health has the right to charge their credit card on file for all services not covered by third-party payors at the time of service or upon notice of denial of payment by a third-party payor.

Full Coverage for Testing and Assessments. Coverage and cost for psychological and psychiatric assessments and tests vary across different third-party payors, and patients have been informed and agree to be responsible for the costs for the tests regardless of whether the costs are reimbursable by third-party payors. This is because not all psychological testing services are covered by third-party payors. Patients have been informed that third-party payors do not fully reimburse psychological testing services, even if provided by an in-network provider. There are a variety of situations when this occurs; for example, when: (a) the third-party payor does not consider psychological testing “medically necessary” for “experimental” or “investigational” diagnoses; or (b) when the third-party payor reimburses for fewer hours than billed by LifeStance Health. Patients consenting to these services understand that they will be fully responsible for payment of all services upon service delivery or upon notice of denial of payment by a third-party payor. Patients grant LifeStance Health the right to charge their credit card on file for all requested services or tests not covered by third-party payors at the time of service or upon notice of denial of payment by a third-party payor.

Collections. Patients agree that if their account is turned over to an attorney or agency for collection, they agree to pay all costs of collection including, but not limited to, court costs and legal and collection fees. If their account is not paid when due, a service fee and/or interest will accrue as permitted by law.

Other Insurance or Litigation Payor Sources. Regarding any administrative or personal injury cases, patient understands and agree to be responsible for fees incurred when due regardless of the outcome of pending litigation. The fees incurred will be in accordance with LifeStance Health’s standard fees for court testimony, depositions, and other litigation support as itemized in LifeStance Health’s then-current chargemaster. Patients grant LifeStance Health the right to charge their credit card on file for all requested services, fees or tests at the time-of-service delivery. If there are any remaining balance(s) due at the time of case settlement, patient authorizes and requires their attorney to pay their outstanding accounts with LifeStance Health in first priority for payment from the settlement proceeds. LifeStance Health does not accept contingency fee arrangements.

Med Pay Coverage. Patients having Med Pay coverage, government payors, worker’s compensation payors, personal injury case defendants, and medical benefits accident insurance payors (“Med Pay”), permit LifeStance Health to classify and treat the Med Pay payor as the primary insurer over any other third-party payors. Patients irrevocably agree to a waiver permitting payment of Med Pay funds directly to LifeStance Health first in priority over me personally and any other potential claimant to the funds.

Forensic Legal Requests. Patients understand that forensic legal requests, conferences, and telephone calls involve additional time and record-keeping for LifeStance Health, and patient agrees to be responsible for all direct costs and expenses incurred by LifeStance Health, and its attorneys and agents, in responding to discovery requests (including depositions and subpoena duces tecum time and labor costs) and relating to conferences (including, but not limited to, court appearances, preparation of reports, photocopying, faxes, long-distance telephone calls, out of office travel, overnight delivery, and courier services). Patient grants LifeStance Health the right to charge their credit card on file for all such requested forensic legal services and documentation time.

Assignment of Benefits. All patients acknowledge and agree that LifeStance Health may receive payments directly from any third party for the non-covered health care services provided by LifeStance Health. Patient agrees and authorizes LifeStance Health to release any information needed to determine benefits payable by a third party or their agents. In the event that the patient receive any payment from a third party for a non-covered health care service, the patient agree to turn over the payment in full to LifeStance Health. In addition to assigning all payments to LifeStance Health for services rendered, patients hereby agree to assign all of their related rights and obligations under their insurance plan to LifeStance Health and its representatives, grant this limited power of attorney, including specifically the right to file claims, litigate and appeal claim denials and pursue causes of action under the Employee Retirement Income Security Act (ERISA) or other laws. Patient hereby permits a signature on file or copy of this Agreement to be used in place of their original signature.

Health Savings Account. Per IRS regulations, if a patient participates in a high-deductible health plan with a health savings account (HSA) feature, the patient may be required to pay a fair market value fee for certain available non-preventive and urgent services until their deductible has been satisfied. Patient understands that if they have an HSA and they do not pay on a fee-for-service basis for these services, they may lose their ability to contribute to their HSA.

Patient’s Accurate and Current Insurance Information. All patients agree to provide and update LifeStance Health with accurate personal information including but not limited to contact information and insurance information. A patient’s failure to update their information may result in denied payments or inaccurate charges.