Collection Efforts. We will make every effort to work with you to make payment arrangements should your bill become outstanding. As a courtesy to you, we will file claims with your insurance carrier. You are ultimately responsible for the charges for the services provided to you. You will receive a monthly statement reflecting balances still outstanding from your insurance carrier for which you are responsible. If your account becomes outstanding, your payments must be regimented to clear your account within a six- month period. If you do not meet your financial obligation, and you refuse to pay on your balance, we reserve the right to refuse care for all subsequent visits. I am aware that I am responsible for my bills in the event the insurance company denies any claims.
Appears in 4 contracts
Samples: Office Policy & Financial Agreement, Office Policy & Financial Agreement, Office Policy & Financial Agreement
Collection Efforts. We will make every effort to work with you to make payment arrangements should your bill become outstanding. As a courtesy to you, we will file claims with your insurance carrier. You are ultimately responsible for the charges for the services provided to you. You will receive a monthly statement reflecting balances still outstanding from your insurance carrier for which you are responsible. If your account becomes outstanding, your payments must be regimented to clear your account within a six- six-month period. If you do not meet your financial obligation, and you refuse to pay on your balance, we reserve the right to refuse care for all subsequent visits. I am aware that I am responsible for my bills in the event the insurance company denies any claims.
Appears in 2 contracts
Samples: Office Policy & Financial Agreement, Office Policy & Financial Agreement
Collection Efforts. We will make every effort to work with you to make payment arrangements should your bill become outstanding. As a courtesy to you, we will file claims with your insurance carrier. You are ultimately responsible for the charges for the services provided to you. You will receive a monthly statement reflecting balances still outstanding from your insurance carrier for which you are responsible. If your account becomes outstanding, your payments must be regimented to clear your account within a six- month periodsix-monthperiod. If you do not meet your financial obligation, and you refuse to pay on your balance, we reserve the right to refuse care for all subsequent visits. I am aware that I am responsible for my bills in the event the insurance company denies any claims.
Appears in 1 contract
Samples: Office Policy & Financial Agreement
Collection Efforts. We will make every effort to work with you to make payment arrangements should your bill become outstanding. As a courtesy to you, we will file claims with your insurance carrier. You are ultimately responsible for the charges for the services provided to you. You will receive a monthly statement reflecting balances still outstanding from your insurance carrier for which you are responsible. If In the event that your account becomes outstanding, your payments must be regimented to clear your account within a six- six month period. If you do not meet your financial obligation, and you refuse to pay on your balance, we reserve the right to refuse care for any and all subsequent visits. I am aware that I am responsible for my bills in the event the insurance company denies any claims.
Appears in 1 contract
Samples: Office Policy & Financial Agreement