Common Contracts
1 similar Patient Financial Agreement contracts
Patient Financial AgreementPatient Financial Agreement • May 2nd, 2016
• Benson Health Clinic participates with Medicare, Medicaid and Commercial Insurances. While Benson Health Clinic may have an agreement with your insurance, it is your responsibility to know if your plan is in network. Benson Health Clinic makes every effort to verify your insurance eligibility, deductible amounts, and co-insurance amounts prior to your initial visit. However, we cannot guarantee the amount stated, as the benefits quoted to us by your insurance are not necessarily a guarantee of payment. Many insurance companies have additional stipulations that may affect your coverage. It is your responsibility to understand and comply with any predetermination of benefits or referral requirements. Please be aware that some, and perhaps all, of the services provided may be non-covered services or may not be considered necessary under your medical insurance company. By contract, covered charges will be paid directly to Benson Health Clinic. Any Applicable co-payment, co-insurance paym
