Common use of ASSIGNMENT OF INSURANCE BENEFITS Clause in Contracts

ASSIGNMENT OF INSURANCE BENEFITS. The undersigned authorizes as the Client/Patient or Parent/Legal Representative of Client/Patient, to direct payment to Harmony of any insurance benefits otherwise payable to or on behalf of the Client/Patient for this treatment, including emergency services if rendered, at a rate not to exceed the Harmony’s regular charges. It is agreed that payment to Harmony, pursuant to this authorization by an insurance company shall discharge such company of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that he or she is financially responsible for charges not covered by the assignment.

ASSIGNMENT OF INSURANCE BENEFITS. The undersigned authorizes as the Client/Patient Patient, or Parent/Legal Representative of Client/Patient, to direct payment to Harmony of any insurance benefits otherwise payable to or on behalf of the Client/Patient for this treatment, including emergency services if rendered, at a rate not to exceed the Harmony’s regular charges. It is agreed that payment to Harmony, pursuant to this authorization by an insurance company company, shall discharge such company of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that he or she is financially responsible for charges not covered by the assignment.

ASSIGNMENT OF INSURANCE BENEFITS. The undersigned authorizes as the Client/Patient or Parent/Legal Representative of Client/Patient, to direct payment to Harmony United Healthcare LLC of any insurance benefits otherwise payable to or on behalf of the Client/Patient for this treatment, including emergency services if rendered, at a rate not to exceed the Harmony’s regular charges. It is agreed that payment to Harmony, pursuant to this authorization by an insurance company shall discharge such company of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that he or she is financially responsible for charges not covered by the assignment.

ASSIGNMENT OF INSURANCE BENEFITS. The undersigned authorizes as the Client/Patient or Parent/Legal Representative of Client/Patient, to direct payment to Harmony of United Healthcare LLCof any insurance benefits otherwise payable to or on behalf of the Client/Patient for this treatment, including emergency services if rendered, at a rate not to exceed the Harmony’s regular charges. It is agreed that payment to Harmony, pursuant to this authorization by an insurance company shall discharge such company of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that he or she is financially responsible for charges not covered by the assignment.