AGREEMENT TO PAY FOR SERVICES if Premium is Not Paid You are not entitled to any services for periods for which the premium has not been paid. If services are received during such period, you agree to pay for the services received.
AGREEMENT TO PAY FOR SERVICES. Associate Company agrees to pay to Service Company the cost, determined as herein provided, of such services as are requested by Associate Company and are provided by Service Company. It is the intent of this Agreement that all disbursements and expenses of the service company for service performed for associate companies are recoverable from such companies , including reasonable compensation for necessary capital as permitted by applicable rules and requirements of FERC under the Act. The methods and procedure for determining the cost of services performed for Associate Company are set forth in Appendix A hereto. Bills will be rendered for each calendar month on or before the twentieth day of the succeeding month and will be payable upon presentation and not later than the last day of that month. Monthly charges may be made in whole or in part for particular expenses on an estimated basis, subject to adjustment. Notwithstanding any other provisions of this Agreement, Service Company shall ensure that all charges billed to Associate Company hereunder shall be reasonable, purposeful and consistent with historical precedent and cost allocations to other System companies.
AGREEMENT TO PAY FOR SERVICES. I understand that I am liable and responsible for any health insurance deductibles and coinsurance portions of my bill. I also understand that I am responsible to pay for all services to be rendered to the patient whether signing as agent or as patient.
AGREEMENT TO PAY FOR SERVICES. I acknowledge and accept that no guarantee has been given as to the results these treatments may produce in me. I further acknowledge and accept that any treatment(s) given may not help me and may make my condition worse. For and in consideration of the care and treatment provided to the patient, I promise to pay, or arrange for payment, Any fees associated with the collection of a past due balance will be the responsibility of the patient.
AGREEMENT TO PAY FOR SERVICES. I agree to pay all charges for services that I incur. If I use insurance to cover some or all of my counseling at Tender Rock Counseling, I agree to pay any amounts that my insurance carrier does not pay. These may include, but are not limited to, services and charges determined by my insurance carrier to be my responsibility or not covered by my insurance plan. If I incur a charge for a missed or late-canceled group therapy session, I understand that I will be responsible for payment of the agreed-upon fee per session.
AGREEMENT TO PAY FOR SERVICES. Associate Company agrees to pay to Service Company the cost, determined as herein provided, of such services as are requested by Associate Company and are provided by Service Company. It is the intent of this Agreement that the payment for services rendered by the Service Company to the System shall cover all the costs of its doing business (less credits for services to non- System companies and any other miscellaneous income items), including reasonable compensation for necessary capital as permitted by applicable rules and requirements of FERC under the Act. The methods and procedure for determining the cost of services performed for Associate Company are set forth in Appendix A hereto. Bills will be rendered for each calendar month on or before the twentieth day of the succeeding month and will be payable on presentation and not later than the last day of that month. Monthly charges may be made in whole or in part for particular expenses on an estimated basis, subject to adjustment, so that all charges for services during a calendar year will be made on an actual basis. Notwithstanding any other provisions of this Agreement, Service Company shall ensure that all charges billed to Associate Company hereunder shall be reasonable, purposeful and consistent with historical precedent and cost allocations to other System companies.
AGREEMENT TO PAY FOR SERVICES. Financial Agreement. In consideration of the services to be rendered to the patient, I individually promise to pay the patient’s account at the rates established in the hospital’s price list (known as the “Charge Master”) as the same are in effect as of the date the charge is processed for the service provided, which rates are hereby expressly incorporated by reference as the price term of this agreement. Some special items will be priced separately if there is no price listed on the Charge Master.
AGREEMENT TO PAY FOR SERVICES. For and in consideration of the services provided to the patient, I promise to pay the above company for all charges and services rendered to or in behalf of the patient. The above company may secure any credit information that may be necessary. I also understand that I may be insured through a PPO/HMO plan and that it is my responsibility to obtain the proper and necessary referrals from my primary care physician before services are rendered. The above company shall make all reasonable efforts to assure that the insured is covered by the plan, but ultimately I understand that it is my responsibility. By way of original or a copy hereof, the undersigned patient hereby directs the applicable personal injury protection or medical payments insurance carrier to make payment directly to the above companies. If payment is made out to the above company they have the authorization to endorse the payment with the patient's signature along with its own. I hereby authorize the above company to release any information in the course of my treatment to my insurance company or any physician needing this information for treatment.
