Private-Pay Disclosure

Effective Date: [Insert Date]

Peña Family Care Services LLC provides home care services on a private-pay basis only. This disclosure is intended to clearly explain our payment structure and prevent misunderstandings regarding billing, insurance, or third-party coverage.

Private-Pay Services Only

All services provided by Peña Family Care Services LLC are private-pay. We do not bill Medicare, Medicaid, long-term care insurance, or any other government or third-party payer. Payment responsibility rests solely with the client or the designated responsible party.

No Insurance Billing

Peña Family Care Services LLC does not submit claims to insurance carriers and does not act as an intermediary with insurance companies. Clients and families are responsible for determining whether services may be eligible for reimbursement under any private insurance or long-term care policy.

Payment Responsibility

The client or authorized responsible party agrees to pay for all services provided in accordance with the agreed-upon rates, minimum hours, and scheduling terms outlined in the service agreement. Failure to maintain timely payment may result in suspension or termination of services.

Transparent Pricing

Rates, minimum visit requirements, and billing schedules are reviewed with clients prior to the start of services. Written agreements are provided to ensure clarity and mutual understanding.

No Guarantee of Coverage or Outcomes

Peña Family Care Services LLC makes no representation or guarantee that services will be reimbursed by any insurance policy or third-party program. Services are provided as non-medical personal care and do not guarantee specific outcomes.

Acknowledgment

By submitting an intake form, requesting services, or engaging in services with Peña Family Care Services LLC, clients and authorized representatives acknowledge and accept this Private-Pay Disclosure.

Peña Family Care Services LLC
Private-Pay In-Home Support