INSURANCE PROCESSING. Your insurance company may require that you pre-authorize your treatment with us prior to your visit. It is your responsibility to monitor insurance benefits, deductibles, as well as effective and termination dates of coverage. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have any questions, please contact your plan administrator. Feel free to speak with your provider if assistance is needed with this. By signing below, the undersigned affirms that he/she has read, understands and agrees to the finance agreement as outlined above. I authorize my insurance company to make payments directly to Richmond Creative Counseling for services rendered. Client Legal Name
INSURANCE PROCESSING. Insurance coverage varies from policy to policy, and it is your responsibility to understand what your insurance plan covers. Questions regarding your individual plan should be directed to your human resources department or insurance provider. As a service to our patients, we assist with insurance processing. We make every effort to maximize your dental benefits, and we will provide you with a complete estimate before any treatment is done. Our policy requires co-payments to be paid at the time of services. You may need to have pre-authorization from your insurance company prior to starting treatment and we will be happy to submit it for you. If you decide to proceed with dental treatment without a pre-authorization, you will be responsible for the full cost of treatment on the day of service.
INSURANCE PROCESSING. 8. HMO CAPITATION REPORT
INSURANCE PROCESSING. The HCS Medical Clinic is not able to process insurance claims for patients since “on campus” medical services are funded by our student’s Health Service fees. For this reason, health care services are billed directly to the camp participant or parent/guardian. HCS Medical Clinic bills are properly coded to enable patients to submit their bills for reimbursement or payment through their primary health care insurance provider, if desirable or possible. Please be aware that not all insurance providers will honor services rendered outside their realm of medical providers. Questions about health insurance coverage, while attending a camp or conference at Eastern, should be directed to the participant’s individual insurance providers.
INSURANCE PROCESSING. Your insurance company may require that you pre-authorize your treatment with me prior to your visit. It is your responsibility to monitor insurance benefits, deductibles, as well as effective and termination dates of coverage. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have any questions, please contact your plan administrator. Fee free to speak with me if assistance is needed with this. By signing below, the undersigned affirms that they have read, understand and agree to the finance agreement as outlined above. I authorize my insurance company to make payments directly to Xxxxx Xxxxx, LCSW for services rendered.
INSURANCE PROCESSING. Your insurance company may require that you pre-authorize your treatment with us prior to your visit. It is your responsibility to monitor insurance benefits, co-payments, deductibles, as well as effective and termination dates of coverage. You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have any questions, please contact your plan administrator. Feel free to speak with your provider if assistance is needed with this. Our financial agreement with you is one aspect of our therapeutic relationship. You have our commitment to your healing and well-being, and this includes our willingness to form a financial contract with you that will be mutually agreeable. By signing below, you affirm that you have read, understand, and agree to the finance agreement as outlined above. I authorize my insurance company to make payments directly to Serenity in Motion for services rendered. Client Printed Name (or parent/guardian if client under age 18) mm/dd/yyyy Client Signature (or parent/guardian if client under age 18) mm/dd/yyyy
