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Welcome to Oklahoma Oncology. The purpose of this information sheet is to help acquaint you with the services and the financial policies of Oklahoma Oncology.
ASSIGNMENT OF INSURANCE BENEFITS
I agree that physician benefits otherwise payable to the insured are
to be made payable to the physician(s) responsible for my care.
Any payment received for this period may be applied to any unpaid
bills for which I am liable, subject to the rules of coordination
of benefits.
PRECERTIFICATION POLICY
I understand that Oklahoma Oncology will assist with insurance
pre-certification requirements, but will not assume responsibility
for pre-certification or any impact which it may have on insurance
payment.
FINANCIAL RESPONSIBILITY
As consideration for the services provided me, payment is guaranteed
for any amount due for such services provided by Oklahoma Oncology.
Charges for services and goods shall be at Oklahoma Oncology billed
charges rates unless otherwise agreed to in writing by Oklahoma
Oncology.
"I hereby assign all medical and/or surgical benefits to Oklahoma Oncology. This assignment will remain in effect until revoked by me in writing. A photocopy of this assignment is to be considered as valid as an original. I understand that I am financially responsible for all charges whether or not paid by my insurance. I hereby authorize Oklahoma Oncology to release all information necessary to secure payment."
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