Common Contracts

1 similar Assignment of Benefits Agreement contracts

ASSIGNMENT OF BENEFITS AGREEMENT
Assignment of Benefits Agreement • August 1st, 2017

Our practice will accept an assignment of benefits from your insurance company with the following provisions. It is important to understand, though, that the agreement regarding your dental benefits is between you, your employer, and your insurance company. The obligation you have with our practice is to pay for all treatment and services we provide to you, 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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