Common use of Paying for your care Clause in Contracts

Paying for your care. A. Who Can be Required to Pay for Your Care. Only you and your insurer can be required to pay for your care. No other person ‑ e.g., a family member, friend, neighbor, legal agent or guardian ‑ can be required to pay for your care from their own funds, although he or she may knowingly and voluntarily agree to pay for the cost of your care. We require you or any other person responsible for making payments on your behalf to pay for your care under the terms of this contract in a timely manner. If you or anyone else with authority to pay for your care on your behalf fails to pay a Facility bill, we may request a court to order such payment. You agree to provide all information requested by us about your health and financial status and to update this information while you are a resident here. You understand that if we later find that you knowingly or willfully provided us with incomplete or inaccurate information, we will consider that as a breach of this Agreement which gives us the right to pursue all legal remedies against you. It is anticipated that your care will be paid for by:  The Medicare Program;  The Medicaid Program (also known as "Medical Assistance");  Other third-party insurer (please specify: ________________________________);  You with your own funds; or  Another person with your funds (please specify: ___________________________);  Another person who has voluntarily agreed to pay with their own funds (please specify:

Paying for your care. A. Who Can be Required to Pay for Your Care. Only you and your insurer can be required to pay for your care. No other person ‑ - e.g., a family member, friend, neighbor, legal agent or guardian ‑ - can be required to pay for your care from their own funds, although he or she may knowingly and voluntarily agree to pay for the cost of your care. We require you or any other person responsible for making payments on your behalf to pay for your care under the terms of this contract in a timely manner. If you or anyone else with authority to pay for your care on your behalf fails to pay a Facility bill, we may request a court to order such payment. You agree to provide all information requested by us about your health and financial status and to update this information while you are a resident here. You understand that if we later find that you knowingly or willfully provided us with incomplete or inaccurate information, we will consider that as a breach of this Agreement which gives us the right to pursue all legal remedies against you. It is anticipated that your care will be paid for by:  Γ The Medicare Program;  Γ The Medicaid Program (also known as "Medical Assistance");  Γ Other third-party insurer partyinsurer (please specify: ________________________________);  Γ You with your own funds; or  Γ Another person with your funds (please specify: ___________________________);  Γ Another person who has voluntarily agreed to pay with their own funds (please specify:: ). It is understood that Medicare and Medicaid will make the determinations concerning your medical and financial eligibility for payment by those programs. You agree to pay either directly or through a third party payer for all items and services provided to you by the Facility. You request that the Facility send your bills to: .

Paying for your care. A. Who Can be Required to Pay for Your Care. Only you and your insurer can be required to pay for your care. No other person ‑ e.g., a family member, friend, neighbor, legal agent or guardian ‑ can be required to pay for your care from their own funds, although he or she may knowingly and voluntarily agree to pay for the cost of your care. We require you or any other person responsible for making payments on your behalf to pay for your care under the terms of this contract in a timely manner. If you or anyone else with authority to pay for your care on your behalf fails to pay a Facility bill, we may request a court to order such payment. You agree to provide all information requested by us about your health and financial status and to update this information while you are a resident here. You understand that if we later find that you knowingly or willfully provided us with incomplete or inaccurate information, we will consider that as a breach of this Agreement which gives us the right to pursue all legal remedies against you. It is anticipated that your care will be paid for by:  The Medicare Program;  The Medicaid Program (also known as "Medical Assistance");  Other third-party insurer (please specify: ________________________________);  You with your own funds; or  Another person with your funds (please specify: ___________________________); or  Another person who has voluntarily agreed to pay with their own funds (please specify:

Paying for your care. A. Who Can be Required to Pay for Your Care. Only you and your insurer can be required to pay for your care. No other person ‑ - e.g., a family member, friend, neighbor, legal agent or guardian ‑ - can be required to pay for your care from their own funds, although he or she may knowingly and voluntarily agree to pay for the cost of your care. We require you or any other person responsible for making payments on your behalf to pay for your care under the terms of this contract in a timely manner. If you or anyone else with authority to pay for your care on your behalf fails to pay a Facility bill, we may request a court to order such payment. You agree to provide all information requested by us about your health and financial status and to update this information while you are a resident here. You understand that if we later find that you knowingly or willfully provided us with incomplete or inaccurate information, we will consider that as a breach of this Agreement which gives us the right to pursue all legal remedies against you. It is anticipated that your care will be paid for by:  The Medicare Program;  The Medicaid Program (also known as "Medical Assistance");  Other third-party insurer (please specify: ________________________________);  You with your own funds; or  Another person with your funds (please specify: ___________________________);  Another person who has voluntarily agreed to pay with their own funds (please specify:: ). It is understood that Medicare and Medicaid will make the determinations concerning your medical and financial eligibility for payment by those programs. You agree to pay either directly or through a third party payer for all items and services provided to you by the Facility. You request that the Facility send your bills to: .