INSURANCE INFORMATION

As a courtesy we will bill your primary insurance carrier if you provide ALL necessary information (such as insurance cards with their CORRECT billing address and REFERRALS). Co-pays are collected for each visit at the time of service.

Statement of Financial Responsibility

I understand my insurance carrier may not approve or reimburse my medical services in full due to usual and customary rates, benefit exclusions, coverage limits, lack of authorization, or medical necessity. I understand I am responsible for fees not paid in full, co-payments, and policy deductibles and co-insurance.