Common Contracts
1 similar Patient Financial Agreement contracts
Client/Patient Financial Agreement with Waterstone Counseling CentersPatient Financial Agreement • December 30th, 2021
Waterstone Counseling Centers, LLC is committed to serving our patients with professionalism, care, and concern. We ensure commitment to your treatment, but also expect commitment from our patients including financial responsibility. This includes providing current and accurate insurance information and making copay payments and/or paying the current balance owed at the time of each in-person or telehealth session. Deductible and co-insurance balances will be determined when claims are processed and the front desk will notify patients of any balance due. During the establishment of new services, patients will be made aware of their financial responsibility based on their insurance information or self-pay status. The terms of their private insurance or self-pay status will be documented, given to patient, and saved in patient chart for reference.
