• Waiver for Non-Covered Services:

    I understand that today I am receiving services that may or may not be covered by my insurance company. The office of Bay Street Pediatrics has notified me that these procedures may not be covered by my insurance company.
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  • If I have requested that this service be performed, I agree to be personally responsible for payment of this service should the claim items be denied by my insurance company
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  • Reminder

    Please remember to check with your insurance company before having any services to make sure they are covered. If you do not have an insurance handbook, please contact your insurance company to obtain one.
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