MEDICARE & MEDICAID: Aegis is an in-network provider for Traditional Medicare Part B and Medicaid. The patient is responsible for any deductible, co-payment, and/or co-insurance amount.
THIRD PARTY INSURANCE CARRIER: Aegis is in-network with many commercial insurance carriers. The patient is responsible for any deductible, co-payment, and/or co-insurance amount.
SECONDARY INSURANCE: If the patient has secondary insurance that supplements primary coverage, Aegis will file a claim with the secondary carrier when provided with the necessary information.
SELF PAY PATIENTS: The patient will be responsible for payment and will receive an invoice from the Aegis Billing Department. If the patient can make payment within 5 days of the test(s), Aegis offers a prompt pay discount.
STATEMENT OF FINANCIAL RESPONSIBILITY: A copy of this Statement of Financial Responsibility and Billing Policy Information will be provided to me upon request, and I understand that I am responsible for all co-pays, de- ductibles, and/or co-insurance, as well as for amounts not covered by insurance, litigation, or third party liability. By signing this authorization, I am authorizing Aegis to submit claims and acknowledging that payment(s) of authorized insurance benefits or attorney settlements, including but not limited to Medicare, Medicaid, third party insurance, other benefits, and/or payments shall be made on my behalf to Aegis Sciences Corporation for the services provided to me pursuant to a Laboratory Request, a copy of which will be provided to me upon request, and I will pay for any amounts not covered by other sources, if applicable.