Common Contracts
1 similar Assignment of Benefits Agreement contracts
ASSIGNMENT OF BENEFITS AGREEMENT FOR MG DENTISTRYAssignment of Benefits Agreement • June 26th, 2014
Although we will complete insurance information forms and submit a claim on your behalf, we do not accept responsibility for the outcome of the transaction. Completing insurance forms is a courtesy we extend to you in an effort to save you time and to facilitate payment to our practice from your insurance company. By having our practice process your insurance forms, it is important that you understand that this does not eliminate your financial obligation for your treatment.
