Submission of Insurance Claims. I understand that Evolve will NOT submit any claims for Services to my insurance plan on my behalf, and that I am solely responsible for submitting such claims if I choose to seek reimbursement from my insurance plan for such Services. I also understand that any reimbursement by my insurance plan will be sent directly to me. If Evolve is mistakenly reimbursed by my insurance plan, then Evolve will return the check to my insurance plan. I understand that my insurance plan may not pay at all for some Services provided by Evolve and may only make a partial payment for other Services provided by Evolve. I further understand that Evolve makes no representations or promises regarding the amount of payment to be received for any claim(s) I may submit to my insurance plan. Medicare and HMOs do NOT permit me to submit claims for Services provided by Evolve, and I agree not to submit a claim for any such services to Medicare or any HMO.
Submission of Insurance Claims. I understand that IHNC will NOT submit any claims for Services to my insurance plan on my behalf, and that I am solely responsible for submitting such claims if I choose to seek reimbursement from my insurance plan for such Services. I also understand that any reimbursement by my insurance plan will be sent directly to me. If IHNC is mistakenly reimbursed by my insurance plan, then IHNC will return the check to my insurance plan. I understand that my insurance plan may not pay at all for some Services provided by IHNC and may only make a partial payment for other Services provided by IHNC. I further understand that IHNC makes no representations or promises regarding the amount of payment to be received for any claim(s) I may submit to my insurance plan. Medicare and HMOs do NOT permit me to submit claims for Services provided by IHNC, and I agree not to submit a claim for any such services to Medicare or any HMO. Termination of this Agreement.
Submission of Insurance Claims. I understand that the Practice will NOT submit any claims for Services to my insurance plan on my behalf, and that I am solely responsible for submitting such claims if I choose to seek reimbursement from my insurance plan for such Services. I also understand that any reimbursement by my insurance plan will be sent directly to me. If the Practice is mistakenly reimbursed by my insurance plan, then the Practice will return the check to my insurance plan. I understand that my insurance plan may not pay at all for some Services provided by the Practice, and may only make a partial payment for other Services provided by the Practice. I further understand that the Practice makes no representations or promises regarding the amount of payment to be received for any claim(s) I may submit to my insurance plan. Medicare and HMOs do NOT permit me to submit claims for Services provided by the Practice, and I agree not to submit a claim for any such services to Medicare or any HMO.
Submission of Insurance Claims. Employer Group understands that Evolve will NOT submit any claims for Services to Members’ insurance plans on behalf of any Member, and that Members will be solely responsible for submitting such claims if they choose to seek reimbursement from an insurance plan for such Services. Employer Group understands that any reimbursement by any insurance plan will be sent directly to the Member. If Evolve is mistakenly reimbursed by an insurance plan on behalf of a Member, then Evolve will return the check to the insurance plan. Employer Group understands that a Member’s insurance plan may not pay at all for some Services provided by Evolve, may only make a partial payment for other Services provided by Evolve. Employer Group further understands that Evolve makes no representations or promises regarding the amount of payment to be received for any claim(s) a Member may submit to the Member’s insurance plan. Medicare and HMOs do NOT permit Members to submit claims for Services provided by Evolve, and Members agree not to submit a claim for any such services to Medicare or any HMO. Employer Group understands and agrees that it will communicate this fact to Members as part of the Evolve enrollment process.
