Non- Covered Services: Please be aware that some- and perhaps all- of the services you receive may be non covered or not considered reasonable or necessary by your insurers. If you fail to provide us with the correct insurance information in a timely manner (48 hours before appt), you will be responsible for the balance of the claim. We must obtain a copy of your driver's license and current valid insurance card to provide proof of insurance. Proof of insurance: All Patients must confirm and/ or complete a patient information form before being seen. Please contact your insurance company with any questions you may have regarding your coverage. Knowing your insurance benefits is your responsibility. You will be required to pay for your visit in full until our office is able to confirm your coverage. If you are covered by a participating plan, but you are either missing an updated insurance card or cannot provide policy and group number, you will be responsible. If you are not insured by a plan, payment in full is expected at each visit. Insurance: SMHWI Participates in most insurance plans, including Medicare. This billing process notification is developed to assist you with understanding your rights and responsibilities when receiving services with SMHWI. We are committed to providing you with quality and affordable healthcare. Thank you for choosing us as your care provider. Social History/Assessment Header Mobile.Michigan Alcoholism Screening Test Header Mobile.Drug Abuse Screening Test Header Mobile.Fillable Nutritional Screening Header Mobile.Authorization To Disclose Header Mobile.Suboxone Treatment In Arizona Header Mobile.Ketamine Treatment In Arizona Header Mobile.Intensive Outpatient Treatment (IOP) Header Mobile.Psychiatric Return to Work Program Header Mobile.Workers’ Compensation Treatment Header Mobile.Psychosomatic Evaluation and Treatment Header Mobile. Substance Abuse Treatment Header Mobile.Outpatient Individual Psychotherapy Header Mobile.General Psychiatric Treatment Header Mobile.New Patient Forms and Resources Header Mobile.
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