Opencare Billing Policy

Billing for Services:

Opencare bills for each Billable Appointment that occurred with an Opencare Provider during a Billing Cycle, at the set Price. Additionally, a nominal monthly Membership Fee is applied, providing Providers with access to Opencare's services and benefits.

Opencare assumes that all requests submitted by patients through the Opencare platform for Providers will be successfully completed as Billable Appointments, unless the Provider indicates otherwise (either by canceling the request or by marking a scheduled patient as a no show).

Prohibited Actions in Billing for Services:

To ensure a transparent, fair, and compliant billing process, Opencare providers are strictly prohibited from engaging in certain practices. Violation of these rules may result in penalties, including but not limited to suspension or termination of the provider's account. These prohibited practices include:

  • Providers may not charge patients additional fees specifically for using Opencare to book their appointments. All billing through Opencare must strictly adhere to the agreed-upon pricing structure without imposing extra costs on patients for the convenience of using our platform.
  • Providers must accurately report to Opencare regarding patient visits and the treatments received. Misleading Opencare by falsifying, omitting, or inaccurately reporting patient visit details or treatment information is strictly prohibited.
  • Providers are expected to accept eligible patient requests without undue discrimination or vetting.
  • In cases where a canceled or contested appointment is confirmed to have occurred with services rendered, Opencare reserves the right to retroactively bill for the appointment as a Billable Appointment.

Opencare Provider Criteria:

  • The provider has been approved as "Eligible" by Opencare.
  • The provider has an active, valid payment method associated with their profile.

Billable Appointment Criteria:

We consider an appointment a "Billable Appointment" when it meets ALL of the following criteria:

  • The patient submits their appointment request with a Provider using the Opencare platform,
  • AND the patient has NOT visited this practice within the past 2 years,
  • AND the patient is 18 years of age or older,
  • AND the patient received treatment at the first instance or following a free consultation scheduled through Opencare (e.g. emergency treatments, checkups and/or cleanings, and comprehensive exams all qualify as Billable Appointments),
  • AND the patient is NOT on an HMO plan or government-funded social assistance program (e.g. Medicare/Medicaid in the US or ODSP in Canada).

Membership Fee

  • Providers are charged a monthly Membership Fee for access to the Opencare platform.
  • The first month's Membership Fee for new Opencare Providers will be prorated based on the activation date.
  • Providers who change their Membership Plan during a billing period will be charged according to the plan that is active at the time of billing.
  • If a provider cancels their membership, the Membership Fee for the month of cancellation will not be refunded and will be included in the final invoice.

Billing Appointment Price:

  • The Price for each Billable Appointment, as well as the monthly Membership Fee, will be made clear to the customer before activating an Opencare Provider.
  • If for some reason there is a Price change agreed upon by the customer and Opencare, each Billable Appointment booked with a Provider will be billed at the price set for the Provider at the time that the appointment was requested.
  • Appointments booked through select external channels or platforms may be subject to modified fees. Opencare will communicate and obtain agreement on these adjustments with the Provider before billing.
  • Opencare reserves the right to adjust pricing and will notify Providers of any changes at least 30 days in advance.

Billing Cycles:

Billing occurs on the 6th day of each month, covering all Billable Appointments and the Membership Fee from the previous month. Detailed receipts, including any adjustments due to membership changes, are provided via invoice accessible through the Opencare platform.

Billing Exemptions and Refunds:

  • An Opencare Provider may request a billing exemption if they believe it does not meet the billable appointment criteria outlined above.
  • In order to validate a billing exemption, we may ask for details about how the patient was contacted, details about the appointment booking, and may follow up with the patient directly to evaluate the reason for the billing exemption.
  • Opencare retains the right to reverse billing exemptions for appointments that are later confirmed and which meet all Billable Appointment Criteria.
  • Refund Policy: Opencare can only process refund requests submitted within 90 days of the original charge. Requests made after this period will not be eligible for a refund.

Late Payment and Non-Payment:

  • Opencare will automatically pause a Provider’s account if a payment is declined and the account balance, including Membership Fees, remains overdue for more than 72 hours.
  • Accounts with overdue balances may be subject to additional actions, including referral to a third-party collections agency, as per the standard Opencare collection process.