Common Contracts
1 similar Financial Policies Agreement contracts
Loudoun Psychiatric Care.Financial Policies Agreement • June 13th, 2015
If you have medical insurance, we are eager to help you receive maximum allowable benefits. In order to achieve this goal, we need your assistance and your understanding of our payment policy. You will be asked to update your personal and insurance information periodically, including providing our office with copies of your information to your insurance card and driver’s license. We are required by law to obtain your signature for permission to release information to your insurance carrier. Our failure to obtain these updates could result in criminal and civil penalties and/or expulsion from your insurance plan. Please assist us in complying with your insurance requirements. We will gladly submit fees for you covered medical services to your insurance company, if your provider is considered in network. However we expect payment of all services rendered within 60 days. It may become necessary for you to pay your account in full if your insurance company fails to pay for services within
