Patient Responsibility of Payment
As a courtesy, Life Care Home Care verifies your benefits with your insurance company. A quote of benefits is not a guarantee of benefits or payment. Your claim will process according to your plan, if your claim processes differently from the benefits we were quoted, the insurance company will side with the plan and will not honor the benefit quote we received.
It is the policy of Life Care Home Care that payment is due prior to the time of service unless other financial arrangements are made in advance. We require all patients to pay their deductible, copay and/or coinsurance payment before each visit. At the conclusion of your visits with us you may be billed for any outstanding balances. If there is a credit, you will be provided a refund promptly. You will be held accountable for any unpaid balances by your plan. We highly recommend you also contact your insurance carrier and check into your coverage for Home Health. Do not assume that you will not owe anything if you have more than one insurance policy.
I, accept responsibility for the co-payment, co-insurance, and any charges that my insurance will not cover. I will refer to the rates for services provided by the agency for the maximum dollar amounts that I may be required to pay. I understand that I am responsible for all non-covered costs, share of cost, or co-payments in consideration for the services I am to receive. All reasonable attempts will be made by Life Care Home Care to collect these payments. I agree to pay for all services rendered by the agency. I understand that a finance charge of eighteen percent (18%) per annum will be charged on all invoices past due for 30 days from the date on the invoice. Should any balance be referred for collection, I further agree to pay all reasonable costs of collection including attorney's fees, disbursements, court costs and interest. I understand that Life Care Home Care reserves the right to discharge me for nonpayment of charges upon two (2) days written notice. If I should be discharged for nonpayment, instructions will be provided for any needed ongoing care or treatment.