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  • ASSIGNMENT OF BENEFITS

  • Integrated Gastroenterology Consultants receives payment for patient care from insurance companies, Medicare, and/or other third party programs.

    • I agree to have my insurance companies, Medicare, and/or other third party programs make payments directly to Integrated Gastroenterology Consultants.
    • I agree to let my doctor(s) submit claims and required treatment information to my insurance companies, Medicare, and/or other third party programs for my care, and receive payments directly.
    • I understand that I must pay all charges, co-payments, and deductibles that are not covered by my insurance companies, Medicare and/or other third party programs.

    Thank you!

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