Please note it is the responsibility of the patient to obtain referrals for treatment. If you have Blue Care Network you MUST have a Global referral before evaluation with specialist.
Financial Policy / Insurance Authorization/Assignment of Benefits
I request that payment of authorized Medicare/or any third-party benefits be made to or on my behalf to Elias H. Kassab M.D. PC, for any services furnished to me by one of its providers. I authorize any holder of information about me to the
Centers for Medicare/Medicaid Services and its agents or any third-party payer any information needed to determine these benefits or the benefits payable for related services
The undersigned acknowledges that he/she has received a detailed copy of the financial, insurance authorization and assignment of benefits policy.