Common Contracts
1 similar Insurance Billing Agreement contracts
Insurance Billing AgreementInsurance Billing Agreement • January 1st, 2014
BE ADVISED THAT BY SIGNING FOR US TO BILL YOUR INSURANCE COMPANY YOU UNDERSTAND THAT AUDITORS FROM THAT COMPANY HAVE THE RIGHT TO COME IN AND INSPECT AND READYOUR FILE. ALL YOUR DIAGNOSTIC INFORMATION IS SUBMITTED TO THEM AFTER EACH SESSION. CONFIDENTIALITY IS NOT PRESERVED WHEN INSURANCE COMPANIES ARE BILLED. IF YOU DO NOT WANT US TO BILL YOUR INSURANCE COMPANY YOU WILL BE RESPONSIBLE FOR THE FULL COST OF SERVICES AT EACH SESSION. IN ADDITION, BY SIGNING THIS DOCUMENT YOU AGREE TO TAKE FULL FINANCIAL RESPONSIBILITY FOR ANY SESSION FEES DECLINED COVERAGE BY YOUR INSURANCE COMPANY.
