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frequently asked questions
Questions? Favored Medical Billing has the answers.
Please fill out ALL required fields in order to submit the form. Thank You!
Because your claims for the services rendered has been processed and a significant amount has been placed under patient responsibility, in order to follow proper insurance billing guidelines, to offer any level of discounts to any balance we are obligated to collect, we are required to have in writing that the amount required causes a financial hardship. By completing and submitting the form below you are stating that the additional patient responsibility deemed by your insurance plan after the processing of your claim(s) is outside of your financial means and is non-collectible, as it will create a financial hardship.
TO BE COMPLETED BY PATIENT:
I can afford a discounted monthly payment plan (due on the 28th of each month)
Please Specify amount to be paid monthly*:
I can afford a one-time settlement amount (40% off my balance due)
Please Specify one-time settlement amount*:
NO, I cannot afford any payment arrangement of any kind
Date of Signature:
TO BE COMPLETED BY
Email Address (for confirmation receipt)*:
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Useful Patient Links
verify insurance coverage (pre baby)
ready for insurance reimbursement (post baby)
request an authorization
how to verify my benefits
I receieved a letter
how to write an appeal
Useful Provider Links
check claims status/claims inquiry
submit a claim
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(the 1 is required in front)
Secure Email: firstname.lastname@example.org
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