Common Contracts
1 similar Financial Responsibility Agreement contracts
FINANCIAL RESPONSIBILITY AGREEMENTFinancial Responsibility Agreement • May 18th, 2018
Please also be advised that your visit may include certain procedures that include, but are not limited to biopsies, microscopic and/or endoscopic examination, wax removal that are not included in the standard office visit. These procedures will be billed separately and in addition to office visit charges. We have become aware that many insurance carriers are classifying these procedures as “surgery” and applying the charges to a higher deductible amount. These will also appear on their statements (or “explanation of benefits”) as “Surgery.” The result may be an insurance payment for an office visit but not a procedure. In such cases, payment for the procedure is the patient’s responsibility. Be assured that we are following accepted billing and coding guidelines and that all procedures are performed in the interest of patient care.
