Patient Election to Self Pay Authorization

$49.00

What is it? This is how the patient can legally opt to not use their provider insurance coverage and pay you directly. Included is a revocation form for if the client chooses to remove this payment option.

Who is it for? Any patient that is looking to avoid insurance and pay out of pocket.

Why do I need it? If you are contracted with insurance companies as a practicing provider and a patient pays cash even though they have insurance coverage. then you as the provider could be in violation of the insurance contract and you could loose your funding from insurance companies. 

When do I use it? Upon collecting individual payment.

Category:
Menu