BAY AREA HEALTH CONSULTANTS - DISCLAIMER

Consent to Bill & Release of Medical Information:
I consent to billing by Bay Area Health Consultants LLC and request that payment of authorized benefits (Medicare, Medicaid, Aetna, WellCare, or any other third-party insurance) be made directly to Bay Area Health Consultants LLC for the product provided to me. I agree to supply any necessary documents or information required for Bay Area Health Consultants LLC to obtain direct payment from my insurance provider. Additionally, I authorize the release of my medical information as needed to determine and secure payment for products and services.
I agree to transfer any payment made directly to me for products or services provided by Bay Area Health Consultants LLC. I also authorize Bay Area Health Consultants LLC to appeal any denied insurance claims on my behalf.

Email & Phone Communication Acknowledgment:
By providing my email address and phone number, I authorize Bay Area Health Consultants LLC to contact me regarding my care and services related to the product I have received. This information will not be used for any other purpose. I acknowledge that portions of these communications may not be encrypted, and as such, Bay Area Health Consultants LLC cannot guarantee the security of information transmitted via email.

For any questions about my rights or privacy, I will refer to Bay Area Health Consultants LLC Notice of Privacy Practices.

Patient Information

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