Common Contracts
1 similar Assignment of Benefits Agreement contracts
ASSIGNMENT OF BENEFITS AGREEMENTAssignment of Benefits Agreement • July 22nd, 2020
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/or your insurance company. The patient has the responsibility to pay our practice for treatment, regardless of the amount we may or may not be reimbursed by your insurance company. The following provisions identify our policies governing insurance claims.
