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Get CA PatientPop Patient Consent/Financial Policy Form

-pays, co-insurance, and/or deductible amounts. If the amount collected at the time of service results in an overpaid claim, a refund will be processed within 30 days once all claims are settled and there is no payment due on any other claim or date of service. INSURANCE COVERAGE Please inform the office of any type of insurance coverage you may have. You are responsible for knowing the specific rules of your insurance carrier. We are contracted (In-Network) with most insurance carriers howeve.

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