I understand that my insurance policy is a contract between myself and my insurance company; AUCP is not involved. In order for AUCP to file claims and accept payments from my insurance company, I understand that I must present current insurance information at each visit and that AUCP will need to verify my health insurance coverage. In the event that AUCP is not able to verify my insurance eligibility and benefits before my visit, I agree to pay for my visit in full at the time of service. A refund will be issued if my insurance pays for the visit. I also understand that I am financially responsible for any services not covered by my insurance company.
When my spouse or a financial guarantor signs this agreement, the spouse or the financial guarantor shall be jointly and individual liable with me. Should my account(s) be referred to an attorney or a collection agency for the collection the undersigned shall pay the actual attorney’s fees (including costs) and collections expenses incurred in in addition to the other amounts due.
When my spouse or a financial guarantor signs this agreement, the spouse or the financial guarantor shall
I understand that my insurance policy is a contract between myself and my insurance company; AUCP is not involved. In order for AUCP to file claims and accept payments from my insurance company, I understand that I must present current insurance information at each visit and that AUCP will need to verify my health insurance coverage. In the event that AUCP is not able to verify my insurance eligibility and benefits before my visit, I agree to pay for my visit in full at the time of service. A refund will be issued if my insurance pays for the visit. I also understand that I am financially responsible for any services not covered by my insurance company.
When my spouse or a financial guarantor signs this agreement, the spouse or the financial guarantor shall be jointly and individual liable with me. Should my account(s) be referred to an attorney or a collection agency for the collection the undersigned shall pay the actual attorney’s fees (including costs) and collections expenses incurred in in addition to the other amounts due.
When my spouse or a financial guarantor signs this agreement, the spouse or the financial guarantor shall
I understand that my insurance policy is a contract between myself and my insurance company; AUCP is not involved. In order for AUCP to file claims and accept payments from my insurance company, I understand that I must present current insurance information at each visit and that AUCP will need to verify my health insurance coverage. In the event that AUCP is not able to verify my insurance eligibility and benefits before my visit, I agree to pay for my visit in full at the time of service. A refund will be issued if my insurance pays for the visit. I also understand that I am financially responsible for any services not covered by my insurance company.
When my spouse or a financial guarantor signs this agreement, the spouse or the financial guarantor shall be jointly and individual liable with me. Should my account(s) be referred to an attorney or a collection agency for the collection the undersigned shall pay the actual attorney’s fees (including costs) and collections expenses incurred in in addition to the other amounts due.
When my spouse or a financial guarantor signs this agreement, the spouse or the financial guarantor shall