Last Updated on October 8, 2024
HeyDoctor Medical Group, P.C., HeyDoctor Medical Group (FL), P.A., HeyDoctor Medical Group (NJ), P.C., and HeyDoctor Medical Group (KS), P.A. (collectively, the “Medical Group”), and its employed or contracted providers (together, with the “Medical Group”, the "Providers" or “we” or “our”) do not currently participate in any insurance plans, including Medicare or Medicaid, and the Providers do not accept any health insurance whatsoever. Services provided by the Providers are 100% self-pay by the Providers’ patients. By agreeing to this form, you acknowledge that: 1) you do not have any health insurance (whether through a PPO, HMO, Medicaid or Medicare or any other insurance plan); or 2) you have health insurance but have elected to self-pay as you do not want to use any insurance benefit for these services, acknowledging that the Providers do not accept any health insurance.
Your insurance policy is a contract between you and your insurance company. It is your responsibility to know your benefits, and how they will apply to your benefit payments, and we take no responsibility to understand or be bound by the terms and conditions of such insurance. By agreeing to this Agreement for Self-Payment of Services, you are electing to purchase services that may or may not be covered by your insurance if you obtained those services from a different provider. You have selected services for purchase from us on a self-pay basis. In other words, you have directed us to treat your purchase of these services as if you are an uninsured patient and you agree to be 100% responsible for full payment of the listed price of the services. There is no guarantee your insurance company will make any payment on the cost of the services you have purchased.
The Providers have provided you with the charges, in advance, for the services you have requested. You agree to pay these charges in full as a self-pay patient, electing not to use an insurance policy benefit. You have selected the services, been informed of their costs, and are willing to accept full financial responsibility for payment.