Use of Insurance. It is understood that if insurance is used to pay for services, the claim will be filed in the name on the clinical record as the “primary patient”. A diagnostic code is necessary for insurance to be used. In some cases information from the record may be requested by the insurance company in order to pay for your treatment. The agency’s sliding fee scale may be used in lieu of insurance; however, due to insurance regulations the minimum fee must be the anticipated insurance payment plus your required co-payment. Name Date
Use of Insurance. Wise Mind Counseling contracts with many major insurance companies and will assist you in understanding covered services by your carrier prior to starting counseling services. Wise Mind Counseling will obtain a quote of benefits on your behalf and advise you of any out-of-pocket costs associated with your plan as they were quoted to us. You, the client, are ultimately responsible for the cost of your treatment and for understanding the coverage offered by your insurance plan. All reasonable efforts will be made to bill and collect from your insurance provider should we be in-network with your insurance provider. You will ultimately be responsible for any costs assigned to patient responsibility or uncovered costs up to the allowable billed rate with your in-network plan. It is your responsibility to notify Wise Mind Counseling of any changes in your insurance coverage at the time the changes occur or prior. Any costs incurred due to lapses in coverage are the responsibility of the client and may not be eligible for retroactive billing to a new insurance plan we were not informed of. An adjuster at your insurance company will ultimately determine the medical necessity of your services as well as any assigned patient responsibility. You agree to be charged for any adjustments as indicated by your insurance. You Agree to allow Wise Mind Providers or billing staff to appeal claims we believe to be processed in error on your behalf to an extent reasonable. Should a decision be overturned a refund will be issued to you at that time. Should a decision be upheld in an initial appeal it will be your choice to continue to make appeals for reprocessing on your own behalf. Any adjustments later made to your account will be refunded to you when notified of the determination. Occasionally insurers may determine that anticipated fees have been met or that copays and coinsurance will be waived for certain services. These decisions are often made without advanced notice and will result in a credit on your account. If a billing credit exists in your account it will be applied to any future service for which you would have patient responsibility that is scheduled within 30 days of the determination being made unless you notify us of preference for a refund. If there are not services scheduled a refund will be issued automatically. Refunds will not be available via cash for accounting/tracking purposes and will be made via check payable to the party listed as person responsib...
Use of Insurance. Most insurance plans have an annual deductible, which must be met prior to reimbursement. If you have such a deductible, this is your responsibility to pay. Some insurance plans require the insured to call prior to the first visit and obtain authorization for a specified number of visits and your counselor is not allowed to call for you. You are expected to provide this authorization information not later than your first visit. If you fail to obtain this authorization prior to your initial visit, some insurance companies reduce or decline reimbursement. In this event, you are responsible for payment. All services rendered are the financial responsibility of the client or the client’s parent or guardian. You are responsible for the payment regardless of insurance coverage. By signing this consent, you are authorizing the provider of services to release information concerning your assessment and/or treatment for insurance purposes and to receive direct payment for services rendered.
Use of Insurance. Proceeds
Use of Insurance. Your insurance will not pay Boston Sports Medicine for custom orthotics, supplies, and shipping and handling. Your insurance will pay Boston Sports Medicine for the time your Physical Therapist provides to evaluate you for custom orthotics, cast your feet, prescribe an orthotic, coordinate with the lab, and issue and check the orthotics when they arrive from the lab. We will bill your insurance company for your Physical Therapist’s time, but it is your responsibility to make sure you have any authorization or referral that your insurance company requires for the two physical therapy visits necessary to issue your custom orthotics. You are also required to pay any amount your insurance assigns you for the two visits whether it be a copayment or deductible. Your second visit, where the orthotics are issued, may be brief, but you are required to pay your portion for that visit to cover all of the time involved in getting your custom orthotics. Generally, that is not covered by the payment your insurance company provides for the first visit, therefore we must bill your insurance for the second visit and charge you the portion assigned for copayment and deductible. You may not simply pick up the orthotics when they arrive without seeing your Physical Therapist. On your first visit, you must pay $225.00 plus tax for one pair of orthotics plus any amount assigned by insurance as copayment. When we receive the correspondence back from your insurance company weeks later, you may receive another bill from Boston Sports Medicine for any additional amount the insurance company assigns you for the first visit. On your second visit, you must pay any amount assigned by insurance as a copayment. When we receive the correspondence back from your insurance company weeks later, you may receive another bill from Boston Sports Medicine for any additional amount the insurance company assigns you for the second visit. Patient Signature: Date: Allston Brookline Swampscott Somerville Watertown Wilmington XX Xxx 000, Xxxxxx, XX 00000 Ph: 000-000-0000 Fx: 000-000-0000
Use of Insurance. 80 10.18 Mitigation................................................. 80
Use of Insurance. In the event any Damages related to a claim by Buyer under this Agreement are covered by insurance, Buyer agrees to use commercially reasonable efforts (which shall not include the commencement of litigation) to seek recovery under such insurance and the amount of Damages incurred by Buyer for purposes of this Agreement shall be reduced by the amount Buyer recovers from any insurer (net of any costs of collecting such insurance payment, including the amount of any co-payment or deductible and less that portion of any premium increase in the next policy period of the applicable insurance policy or replacement insurance policy that results directly from the assertion of such claim, as determined by correspondence from the insurance carrier or insurance broker to Buyer, a copy which shall have been provided to the Sellers) and Buyer shall refund amounts received from the Sellers up to the amount of indemnification actually received for any such Damages; provided that the filing of a claim with any insurer for such Damages shall not delay (or prior to receipt of an amount from an insurer, reduce) any payment due to Buyer under this Section 10.
Use of Insurance. PROCEEDS -----------------------------
Use of Insurance. In the event of damage to the Improvements, the proceeds of any insurance policies payable by reason of such damage shall be applied, at Mortgagee’s option, to either the Obligations, whether or not then due and payable, or to the restoration of the Improvements.
Use of Insurance. Reimbursements Income from compensation for injuries and damages may be used to increase the appropriate budget expenditure provisions. Amounts unused by the end of the budget year shall be transferred to subsequent years.
