Insurance Terms and Agreements

• Integrated Behavioral Care makes every effort to provide the most up to date information the insurance company has regarding member eligibility and benefits. However, we cannot guarantee that the information has not changed, was given incorrectly, or will not change since being obtained. The information obtained from the member's insurance company is not a guarantee of payment. Benefits are subject to eligibility at the time of service and all plan conditions, limitations and exclusions. We encourage all clients to verify their eligibility and benefits information with their insurance company as well. 
• I understand that if my insurance plan has a deductible, I am responsible for paying claims in full within 30 days of receipt of balance due in order to ensure my account remains in good standing.
• I understand that it is my responsibility to keep my insurance information updated with IBC and failure to do so may result in payment being due in full for services if the new plan is not accepted. 
• HSA, HRA, or FSA can be accepted at IBC. The payment arrangement varies depending on plan type and plan company. Please contact our billing department if you have one of these benefit types you would like to use at IBC.
   
• By opting to use my health insurance for services, I understand and agree to the following: 
  • I authorize the release of information from my medical record to the insurance company or other third-party payer named above. This information shall include all information necessary to submit and process claims, such as my name, date of birth, address, medical diagnosis, and services provided to me. 
  • If the practice has already shared information with the insurance company or other third-party payer at the time I revoke this authorization, it is too late to prevent that information from being shared. 
  • This authorization is necessary for the practice to determine eligibility for treatments or benefits or to pay for treatments I receive, but the practice cannot condition treatment on the provision of this authorization. 
  • This authorization shall be effective from the date of my signature, unless I contact the practice in writing any time prior to then to revoke. 
  • If you are using Medicare benefits, you also agree to the following: I request that payment of authorized Medicare benefits be made either to me or on my behalf to the name of provider of service and (or) supplier for any services furnished to me by that provider of service and (or) supplier. I authorize any holder of medical information about me to release to the Centers for Medicare and Medicaid Services and its agents any information needed to determine these benefits or the benefits payable for related service. 
  • In consideration of the services provided to me, I assign all benefits to the practice, if accepted, and authorize this insurance company to make payments directly to the practice and its affiliates on my behalf.