![]() ![]() I hereby authorize my insurance benefits to be paid directly to the above-signed physician realizing I am responsible to pay non-covered services and I hereby authorize the release of pertinent Should it become necessary for us to utilize the services of an outside collection agency in order to collect the amounts that are owed, you will be liable for agency/attorney fees.Īssignment of Benefits and Medical Record Release We are required under our contract with these plans to collect these amounts from you.Īll previous balances are to be paid in full prior to additional services being rendered. Co-payments will be collected prior to being seen by the doctor. Most of the members covered under HMO plans also owe co-payments. Our contract with these plans to collect these amounts from you. Co-payments, deductibles and co-insurance are requirements of your insurance plan and we are required under If your plan has a co-payment, you will be expected to pay your co-payment prior to being seen by the doctor. ![]() This may be in the form of co-payment,ĭeductible, or co-insurance. If the physician is contracted with your plan, the majority of members covered under this type of plan are still required to make some type of payment for service that is rendered to them. We accept cash, checks, Visa, MasterCard, Discover and American Express. Fallon Community Health Plan Select Care, Fallon MassHealthįull payment is due at the time of service.BlueCross PPO, POS, HMO, Indemnity, Medicare Advantage.Please check with your health insurance carrier to verify specific coverage. Saint Vincent Medical Group accepts most major health plans as well as Medicare and Medicaid. ![]()
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