Last Updated: August 27, 2025

These Supplemental Payment Terms (“Payment Terms”) set forth additional terms and conditions relating to your payment of costs and fees associated with your use of services provided by Believe in Yourself Therapy, LLC (“Services”). These terms are in addition to, and not in lieu of, your obligations under any other agreed-upon financial terms (including, without limitation, those stated at “Assignment of Benefits / Financial Responsibility / Telehealth Consent” and any other applicable practice policies, which are fully incorporated by reference herein).

Believe in Yourself Therapy, LLC may update these Payment Terms at any time in its sole discretion. Material changes to these Payment Terms will be communicated to you in writing or posted in a prominent place. Please check for updates regularly. All modified terms and conditions will be effective at the time they are provided to you, unless a longer notice period is required by applicable law or unless a specific effective date is noted. If any modified terms and conditions are not acceptable to you, your sole remedy is to cease using the Services. By continuing to access or use our Services after such updates, you agree to be bound by the updated Payment Terms. These Payment Terms may not otherwise be modified or amended, except with the written agreement of both parties.

1. Payment Authorization

When you provide your Payment Authorization to Believe in Yourself Therapy, LLC, you authorize us to charge your credit card, debit card, HSA or FSA Card, and/or financial account number (collectively, “Payment Method”) in connection with any and all provider sessions you receive, and further authorize us to maintain your Payment Method on file to pay for any and all such sessions until you revoke your authorization.

2. Variable Payment Amounts and Timing

You understand and agree that the amount charged to your Payment Method and the timing of that charge depends on, among other things, the amounts charged for services, the amounts your insurer pays on your behalf for your provider sessions, the timing of your insurer’s payment of those amounts, and the timing of your sessions.

Believe in Yourself Therapy, LLC may provide you with an estimate of the amount you would owe for each session at the time you schedule, but this amount could change depending on a number of factors, including your provider costs, your insurance policy, or the nature of your appointment. Your Payment Method will typically be charged the estimated amount immediately after completion of your provider session.

After your session is completed, a claim may be submitted to your insurer, who will determine the amount it will pay for the session, as well as your cost-sharing responsibility. Based on this determination, the final amount you owe for that session will be calculated. Any additional amounts owed beyond the estimate will be charged to your Payment Method. You authorize us to charge your Payment Method both for the estimated session cost immediately after your session, and for any additional amounts owed upon receipt of your insurer’s final determination. You may be notified (typically by email) before any additional charge is processed. Adjustments may also occur to reflect refunds, errors, chargebacks, or other necessary corrections.

3. Revoking Your Payment Authorization; Valid Payment Method

You may revoke your Payment Authorization at any time by contacting Believe in Yourself Therapy, LLC in writing. Revoking your Payment Authorization, however, will not affect any charges that are pending or have already been processed. You must maintain a valid form of payment on file until you have received a final payment notification and paid in full all amounts owed or pending.

If you revoke your Payment Authorization and have a provider session for which you have not yet been fully invoiced or charged, you must provide another valid Payment Method to complete payment for that session. You will remain liable for any outstanding balances or fees that result from your use of our Services.

4. Updates to and Sufficiency of Your Payment Method

You are responsible for ensuring that your Payment Method is valid, active, and has sufficient funds or credit available to cover the amounts owed for your provider sessions. You agree to update your Payment Method promptly if it changes or expires. Believe in Yourself Therapy, LLC is not responsible for any charges that exceed your credit limit or costs you incur due to non-sufficient funds.

Supplemental Payment Terms

Supplemental Payment Terms

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