As a convenience, Financial District Foot & Ankle Center will bill your insurance company for fees and services.
Information received by your insurance company does not pre-authorize payment. In order to receive benefits, the member must be covered at the time of service. The benefits information received by FDFAC is not all-inclusive. It is limited to some coverage highlights. Other terms and limitations may apply even though such provisions are not indicated by your insurance provider. All claims are subject to medical review, (by your insurance provider), according to the information submitted by the provider of the service and are subject to benefit maximums and other terms of the member's contract. Please refer to your applicable benefit agreements to determine the appropriate payment amounts and any limitations or exclusions.
FDFAC contracts with an outside billing company, (Computer Billing Services), to handle all billing and insurance payment questions.
FDFAC is not a HMO Contractor, a Workers Comp Provider, a participant of Covered California or any equivalent. FDFAC does not have a contractual relationship with the entities mentioned in this paragraph.
Assignment of Benefits: I hereby assign payment directly to Financial District Foot & Ankle Center, the insurance benefits otherwise payable to me. I understand that I am financially responsible for the charges not covered by this authorization. I also authorize a photocopy of this assignment as if it were an original copy. If it becomes necessary for the account to be referred to an attorney for collection or suit, the undersigned shall pay the reasonable attorney’s fee and collection expenses. Further, I understand that coinsurance, unsatisfied deductible amounts, etc. are requested at the time of services unless other financial arrangements are made in advance.