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
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Samples: Financial Agreement, Financial Agreement, Financial Agreement