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Patient Estimates

Disclaimer

Continuing acknowledges this as an ESTIMATE for services and is not a guarantee of the charges or benefits for a service. The ESTIMATE is based on the information known and provided at the time of the estimate. The information used to create the estimate has been provided by you. Actual amounts owed for services rendered may be more than, or less than the ESTIMATE provided. This is based upon your specific medical needs at the time of the service, including treatment or services deemed necessary by the physician during the visit and additional information provided by your insurer. Final determination of eligibility and benefits are determined at the time the claim is processed by the insurance company. Co-pays, deductibles, co-insurance and any maximum benefits are determined by your payer and will be provided to you via their explanation of benefits as to your responsibility for payment. Any services determined non-covered under your plan are your responsibility for payment. Please contact our Financial Clearance Department at 216-957-2325 with any questions. This document may contain privileged and/or confidential information that is legally protected. This information is intended only for the use of the intended recipient. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or action taken in reliance on the contents of these documents is strictly forbidden.

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