Self-Pay. All eligible employees who fall below the required hours for Health & Welfare coverage shall be permitted to self-pay up to the time period for extended coverage established by federal legislation provided they do so in accordance with the standards and procedures established by the trustees/federal legislation.
Self-Pay. All eligible Employees, as determined by Section 3 above, who fall below the required hours for Health and Welfare coverage or who terminate their employment shall be permitted to submit to the Fund self-payments for up to the amount of time required under the Comprehensive Omnibus Budget Reconciliation Act of 1986 (“COBRA”).
Self-Pay. If you do not want to use health insurance you may elect to pay directly for psychotherapy and treatment services provided under the Outpatient Services Agreement. Please note that KMC does not offer sliding scale or reduced-fee rates.
Self-Pay. Payment in full is due at the time of service if you do not have health insurance, and for items not covered by insurance. We accept cash, money orders, check, Visa, MasterCard, Discover and Care Credit. A $35 fee will be assessed for all bad checks. NON-COVERED SERVICES: Please be aware that some of the services you receive may not be covered or may not be considered reasonable/customary/necessary by Medicare or other insurers. You are responsible for payment for those services. REFERRALS / AUTHORIZATIONS: We do not require a referral t be seen UNLESS required by your insurance plan. If you arrive for an appointment and the necessary referral or authorization is not in place, you will be given the option to reschedule or pay for those services at the time they are given. We will do all that we can to help you get these in place, by ultimately it is your responsibility to understand your plan's referral/authorization requirements. NSFAC may refer patients to other providers, facilities and labs. We are not responsible for these entities. The patient should contact these outside service providers, facilities or labs directly regarding any billing questions.
Self-Pay. If you choose to self-pay for services please know that PAYMENT IN FULL is due at the time of service. IF YOU NOW SHOW OR LATE CANCEL (LESS THAN 24 HOURS NOTICE WITHOUT PROOF OF REASON) YOU WILL BE CHARGED FOR THE FULL PAYMENT PLUS THE $50.00 NO SHOW/LATE CANCEL FEE.
Self-Pay. I, understand that the Xxxxx Center medical staff are non- participating with my current insurance plan carrier and therefore accept responsibility for payment of services at the time service is rendered. Furthermore, I understand that my current insurance plan will not be billed on my behalf for fees paid. In the event that you need assistance in dealing with reimbursement issues with your insurance company, please contact the Health Care Bureau of the NYS Attorney General at 1-800-428- 9071. For additional resources, please call Healthcare Advocates, Inc. at (000)-000-0000, or visit their website: xxx.xxxxxxxxxxxxxxxxxxx.xxx. If you are unable to keep your scheduled appointment, please notify us at least 48 hours in advance so that we can accommodate our other patients with a vacant appointment. You may also reschedule your appointment at that time. Failure to provide our office with 48 hour notification will incur a missed appointment fee or loss of deposit. Being more than 15 minutes late may result in the need to reschedule your appointment.
Self-Pay. If I do not have insurance, or have an insurance that is not accepted, I will be billed at 110% of the current Medicare rates for Santa Xxxxx County. To receive the most current costs, I may contact BASS Medical Group Billing Services.
Self-Pay. If you do not have insurance, you elect to process your own insurance claims, or our practice does not participate in your insurance plan, payment in full is due at the time of service. REFERRALS/AUTHORIZATION: You are responsible for obtaining a referral or authorization from your primary care physician if required by your insurance prior to the provision of services. If such authorization or referral is not obtained, you will be responsible for payment in full at the time of service.
Self-Pay. If you wish to waive your insurance coverage and be seen on a Self-Pay basis at SDFC for all services, including but not limited to the New Patient Consultation, please check the box below: I/We acknowledge and agree to waive my insurance for any and all medical services at San Diego Fertility Center. I/We understand I/we will be seen on a Self-Pay basis and will be 100% responsible for any associated charges pertaining to these services. If you do not have insurance coverage and will be seen on a Self-Pay basis at SDFC for all services, including but not limited to the New Patient Consultation, please check the box below: I/We acknowledge and agree to receive medical services at San Diego Fertility Center on a Self-Pay basis. I/We understand I/we will be 100% responsible for any associated charges pertaining to these services.
Self-Pay. I am considered self-pay and understand that I am responsible for providing Community Health all of the paperwork required to determine if/where I fall on the sliding fee scale. I further understand until all fee scale requirements are met, I will be responsible for 100% of all charges.
