Common use of Non-Participation in Insurance Clause in Contracts

Non-Participation in Insurance. You acknowledges the Patient’s understanding that neither the CLINIC, nor its Dentist, participate in any health insurance or HMO plans or panels and can- not accept Medicare payments. We make no representations that any fees that You pay under this Agreement are covered by your health insurance or other third party payment plans. It is the Pa- tient’s responsibility to determine whether reimbursement is available from a private, non-gov- ernmental insurance plan and to submit any required billing on Your own.

Non-Participation in Insurance. You acknowledges the Patient’s understanding The Patient understands and agrees that neither the CLINIC, nor its DentistPhysician, participate in any health insurance or HMO plans or panels and can- cannot accept Medicare paymentseligible patients. We make no representations that any fees that You pay under this Agreement are covered by your health insurance or other third party payment plans. It is the Pa- tientPatient’s responsibility to determine whether reimbursement is available from a private, non-gov- ernmental nongovernmental insurance plan and to submit any required billing on Your ownbilling.

Non-Participation in Insurance. You acknowledges the Patient’s understanding understand that neither the CLINICClinic, nor its DentistProvider, participate in any health insurance or HMO plans or panels and can- cannot accept Medicare paymentseligible patients. We make no representations that any fees that You pay under this Agreement are covered by your health insurance or other third party payment plans. It is the Pa- tient’s Your responsibility to determine whether reimbursement is available from a private, non-gov- ernmental governmental insurance plan and to submit any required billing on Your ownbilling.

Non-Participation in Insurance. You acknowledges Your initials acknowledge the Patient’s understanding that neither the CLINIC, nor its DentistPhysicians, participate in any health insurance or HMO plans or panels and can- cannot accept Medicare paymentseligible patients. We make no representations that any fees that You pay under this the Agreement are covered by your health insurance or other third party payment plans. It is the Pa- tientPatient’s responsibility to determine whether reimbursement is available from a private, non-gov- ernmental governmental insurance plan and to submit any required billing on Your ownbilling.

Non-Participation in Insurance. You PATIENT acknowledges the Patient’s understanding that neither the CLINIC, CLINIC nor its Dentist, PHYSICIAN participate in any health insurance or insurance, HMO plans or panels and can- not accept Medicare paymentspanels. We make no representations that any fees that You YOU pay under this Agreement are covered by your health insurance or other third party payment plans. It is the Pa- tientPATIENT’s responsibility to determine whether reimbursement is available from a private, non-gov- ernmental governmental insurance plan and to submit any required billing on Your own.information or documentation. PATIENT acknowledges that this Agreement does not provide comprehensive health coverage, only the health services as described

Non-Participation in Insurance. You The Patient acknowledges the Patient’s understanding that neither the CLINIC, Clinic nor its Dentist, Physician participate in any health insurance or HMO plans or panels and can- not accept Medicare paymentspanels, including Medicare. We make The Clinic makes no representations that any fees that You pay paid by Patient under this Agreement are covered by your health insurance or other third third-party payment plans. It is the Pa- tientPatient’s responsibility to determine whether reimbursement is available from a private, governmental or non-gov- ernmental governmental insurance plan and and, further, it is the Patient’s responsibility to submit any required billing on Your ownclaims.

Non-Participation in Insurance. You This acknowledges the Patient’s understanding that neither the CLINIC, nor its DentistProviders, participate in any health insurance or HMO plans or panels and can- cannot accept xxxx Medicare payments. for eligible patients.We make no representations that any fees that You pay under this Agreement are covered by your health insurance or other third party payment plans. It is the Pa- tientPatient’s responsibility to determine whether reimbursement is available from a private, non-gov- ernmental governmental insurance plan and to submit any required billing on Your ownbilling.