Often, we are asked to provide services not reimbursed by insurance and above and beyond what is a reasonable extension of a service provided for a medical condition. These services might include writing a letter, FMLA form completions, insurance forms, disability forms, or sending a fax at your request. Under those circumstances, a reasonable charge will be requested prior to completing the requested services, which you will be notified of the cost.
Other Non-Covered Services
These policies help the office provide quality care to our valued patients.
If you have any questions or need clarification of any of the above policies, please feel free to contact us.
I agree to abide by the policies of the office and understand that if I do not, I may be asked to seek care elsewhere.
Acknowledgement Signature Required on Demographic Form.
East Lincoln Family Health Professionals, PC. RESERVES THE RIGHT TO CHANGE AND/OR MODIFY THE INFORMATION ON THIS SITE AT ANY TIME.