Insurance Assignment Form Sample Contracts
INSURANCE ASSIGNMENT FORMInsurance Assignment Form • December 29th, 2022
As a service to you, we can accept your insurance assignment. We file insurance claims as a courtesy to our patients. You are responsible for the deductible and co-pays at the time of service. When we receive payment from your insurance company, we will settle any differences. Medicare will not pay for any hearing aids. Medicare or TRICARE will not pay for the initial office visit with the history portion of your first hearing test. Therefore, you will need to pay for this portion of the service at check-in.
Insurance is a contract between you and your insurance company.Insurance Assignment Form • August 10th, 2020
As a service to you, we can accept your insurance assignment. We file insurance claims as a courtesy to our patients. You are responsible for deductible and co-pays at the time of service. When payment is received from your insurance company, any differences will be settled. Medicare will not pay for any hearing aids. Medicare and or Tricare will not pay for the Initial office Visit with History portion of your first hearing test. Therefore, you will need to pay for this portion of the service at check in.
Insurance is a contract between you and your insurance company.Insurance Assignment Form • March 8th, 2021
As a service to you, we can accept your insurance assignment. We file insurance claims as a courtesy to our patients. You are responsible for deductible and co-pays at the time of service. When payment is received from your insurance company, any differences will be settled. Medicare will not pay for any hearing aids. Medicare or Tricare will not pay