Common use of OUT-OF-POCKET MAXIMUM Clause in Contracts

OUT-OF-POCKET MAXIMUM. Your out-of-pocket maximum is not the same as your deductible. Generally, it is the total out-of-pocket limit INCLUDING deductible, co-pays, and co-insurances before the insurance will pay 100% of all covered services. Once again, this varies between insurance policies. If you have any questions, please call your health plan to have further clarification. We are out-of-network for all other plans not listed. You can still be seen, but you will have to pay for all the charges incurred at the time of service with us determined by our fee schedule, NOT at contracted insurances rates which tends to be lower than cash market rates. We will be happy to provide you with an itemized list of coded diagnosis and charges which you can submit to your insurance to receive reimbursement for out-of-network services you have received. Please note that we do not guarantee that you will be reimbursed for the full amount of charges incurred. In fact, it varies depending on limitations and restrictions of your plan. We understand that health insurance coverage is difficult and outright confusing to understand at times. We encourage you to ask questions. If we can be of any assistance, please ask. Once again, this is a very broad explanation of an insurance policy. However, for more specific answers to any of your questions, please call your insurance. By signing this form, you have read and understand our policy. Patient’s Name: Date: