Common Contracts
1 similar null contracts
Billing Services Agreement – To be signed and kept on file for all SPC patients.February 4th, 2014
Insurance Billing: If we are “in-network” for your insurance we will submit the claim directly to your primary insurance. After your insurance(s) completes payment to us you are responsible for payment of any allowable remaining patient balance. If we know at the time of your visit that there will likely be charges for tests or procedures that will not be paid by your insurance you will be asked to sign a release form (ABN) acknowledging your responsibility for payment of these services should your insurance not pay for them. We will ask for a copy of your insurance card as verification of your insurance.
