Transcription of INFORMATION REGARDING INSURANCE AND BILLING
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INFORMATION REGARDING INSURANCE AND BILLING
By signing my name below, I certify that I have read the above INFORMATION . Any questions concerning these policies have been discussed. My signature also certifies my understanding of and agreement with the above policies. I understand I am responsible for all charges not paid by INSURANCE . A photocopy of this document is as valid as the original. You may receive a copy of this document upon _____Patient (or Guardian) Signature INFORMATION REGARDING INSURANCE AND BILLINGIt is your responsibility to understand your INSURANCE benefits. If you are not sure if a service or treatment is covered you should contact your INSURANCE carrier. We do not provide INFORMATION about copayments, coinsurance, or deductibles.
By signing my name below, I certify that I have read the above information. Any questions concerning these policies have been discussed. My signature also certifies my understanding of …
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