Hello all. Happy Memorial Day. I just received response to DV by CA for medical services. Responded with ink writing at bottom of MY cover letter (date and per your request) , did not send back disclosure request form and included patient consent to treat form/bal pending print out and patient information print out. Consent to treat is only document w/ my signature on it. It is a copy, not original and states nothing pertaining to payment except the following, and I quote: 3. Acknowledement (yes they spelled that incorrect) of Responsibility of Payment I authorize my insurance company to forward to ________(OC) , all benefits I am entitled for medical expense with regard to the services above reported. I understand I am financially responsible to _________(OC) for charges not covered by this authorization. All proceeds I receive from my insurance company, along with co-payments and dedcutibles required by my plan, will be paid promptly to the center. Patient Signature& Date / Wittness Signature & Date. Firstly, I had no insurance at time of this visit. Does this paragraph validate my debt? There are no services listed on the page with the signature. Balance owed print out just says mode: Unpaid. Patient info sheet does have social,date of birth on it. However, has P.O. Box on it w/ old ph.# no insurance info, no secondary insurance info and the bottom statement that probably should have been signed by me with the sentence I understand I am personally responsible for amount not covered by insurance is not signed or dated by me. I personally see no debt validation in this at all....do you? Where should I go from here guys? Thanks in advance! Reatha
