Lab Financial Consent Form

Insurance for Labs and Screenings

In the current managed care environment, there are many misunderstandings We would like to clarify some of these with you here.

• Insurance is your responsibility. Your insurance is a contract between you and your insurance company. We cannot become involved in disputes between you and your carrier regarding your benefits or level of coverage.
• It is not our responsibility to get your insurance to pay your claims.
• Our office uses LabCorp and Quest Diagnostics for lab services. Before having labs drawn, please verify with your insurance company to make sure your child is seen at the correct location.
• For screenings that are not paid by your insurance, you may be responsible for charges in addition to your copay, coinsurance, or deductible.

By signing:

I have read and understand that I am personally responsible for verifying my insurance coverage