We will bill your insurance company on your behalf. To properly bill your insurance company, we require that you
disclose all insurance information, including primary and secondary insurance, as well as any change of insurance
information.
It is your responsibility to notify our office promptly of any patient information changes (ie, address, name,
insurance information) to facilitate appropriate billing for the services rendered to you. Failure to provide
complete and accurate insurance information may result in the entire bill being categorized as a patient’s
responsibility.
Although we may estimate what your insurance company may pay, it is the insurance company that makes the final
determination of your eligibility and benefits. You agree to pay any portion of the charges not covered by
insurance, including but not limited to co-pay, deductible, coinsurance, and non-covered charges.
