Common Contracts
1 similar Assignment of Benefits Agreement contracts
ASSIGNMENT OF BENEFITS AGREEMENTAssignment of Benefits Agreement • January 31st, 2022
The University of New England Oral Health Center is pleased to accept your insurance assignment if you are in active status with Maine Care and or are in a participating Delta Dental plan at the date of service. We will bill your dental carrier for the services performed as a courtesy, we will collect all co-pays and deductibles prior to treatment commencing. We will not be responsible for inaccurate estimates of co-pays or benefits, as payment by your dental carrier is not guaranteed. Ultimately any services denied or not paid by your insurance become patient responsibility. Dental insurance payments are generally received within 30 days from time of billing. If we have not received insurance payment at the end of 60 days, we reserve the right to bill the patient for the remaining balance and the patient may seek direct reimbursement from the insurance company. If you should have questions or concerns as to your dental coverage for a particular procedure, we recommend you either conta
