The billing form advises how our billing process works as well as who to contact for additional questions. It reviews how we contact you and if you provide a mobile number as your primary contact then you are giving us permission to all you on that number, either manually or using an auto dialer system.
Your phone number is used to contact you for any health-related information, or billing information. We never sell your information or will use it for any reason other than for your direct care or to contact your regarding your care.
If you have any questions on who this will be shared with you can refer to your Consent of Admissions or your Terms and Conditions. This information is shared with individuals that are involved in your care and in the billing process for your care.
This form is active for one year and will remain on your chart unless you decide to change the TCPA consent or have a new mobile phone number. At that point you can complete a new form during your next check-in.
This form is active on your chart unless you decide that you no longer want the form on file. At that point you can contact us at the number on the form and they will work with you to change the decision and have it documented on your records.
We completely understand that we will need to have another number to contact you at and we will have you sign this form that you do not want us to call you on your mobile number.
If you choose not to sign below, please provide us with an alternative phone number to use to communicate billing information to you. If neither a signature nor an alternate number is provided, you will continue to be liable for any amounts designated as patient liability.
Customer Service Billing Department 1-800-549-3720.
No, TCPA is only for medical billing balances due.
Yes, a new TCPA document will need to be collected since you are now the Guarantor of your own account.