Health Insurance

Please correct the errors described below.

As a courtesy to you, Comprehensive Mental Health Services (CMHS) can submit insurance claims on your behalf. At CMHS, we hope this will make it easier and faster for you to receive insurance reimbursement. In order to do so, we require the policyholder's information and the patient's/client's consent, found below.

Please know we do not have the staff to track whether insurance claims actually go through, or whether they are paid as anticipated. Accordingly, it is your responsibility, exclusively, to detect and manage any difficulties that may arise.

I consent to let CMHS share my protected healthcare information with my insurance carrier for purposes of billing and reimbursement, and I expect the policyholder to receive the latter directly. I will pay CMHS for and at the time same time of service.

Policyholder Information

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