Examples of Secondary Insurance in a sentence
Please include a copy of your Explanation of Benefits if submitting for a Secondary Insurance Benefit.
Co. Address: City: State: Zip: Policyholder Name: DOB: SSN#: Home Address: Phone #: Employer: Work #: Employers Address Secondary Insurance: If you have a secondary insurance, please notify the front desk.
If my insurance has changed or is terminated at the time of service, I agree that I am financially responsible for the balance in full.If I am a Medicare patient, I understand that I need to provide the office with both my Medicare Insurance ID Card and my Secondary Insurance ID Card.
Secondary Insurance is the insurance carrier or third-party payee that would process its payment for a claim after a primary carrier made payment and make any additional payments as necessary.
Pine Creek Vision Clinic does not bill Secondary Insurance, if the claim does not cross over it is the patient’s responsibility to bill insurance.
Lenoir-Rhyne University Secondary Insurance Policy Lenoir-Rhyne University Athletics does not require insurance coverage for participation, the Athletic Training Department highly recommends each athlete have some type of basic health plan with guaranteed coverage, regardless of existing medical conditions.
Patient/Guardian Signature: Date: INSURANCE INFORMATIONPrimary Insurance Carrier: Policy# Group# Secondary Insurance Carrier: Policy# Group# *A copy of your insurance card(s) will be kept on file.
When referred to a team physician, the athlete shall provide their primary insurance and will be given a secondary insurance packet to provide when checking into the front desk, which provides them with instructions on filing with our Secondary Insurance provider.
Secondary Insurance Please inform us of any secondary insurance you may have.
Medical Information – Primary Doctor Info & Medical Info Primary Insurance –Medical Insurance Info Secondary Insurance –If applicable Guardian 1 –Parent/Guardian Into Guardian 2 –Parent/Guardian Into Emergency Contact – Contact, if Parent/Guardian canNOT be reached.