Common Contracts

1 similar Assignment of Benefits Agreement contracts

ASSIGNMENT OF BENEFITS AGREEMENT
Assignment of Benefits Agreement • June 23rd, 2010

Our office will accept an assignment of benefits from your insurance company with the following provisions. It is important to understand the contract regarding your dental benefits is between you, your employer, and your insurance company. The obligation you have to our practice is to pay for your treatment, regardless of the amount that may or may not be reimbursed by your insurance company. The following provisions identify our policies governing insurance claims.

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