It is the parent/guardian’s responsibility to notify Rand Speech Pathology doing business as The Joshua Tree LLC of any changes in insurance information. We require payment at the time of service, however, as a courtesy to our families, we will file your claims with your insurance company.
Parents/ Guardians are ultimately responsible for their child’s therapy bill.
Assignment of Benefits / Authorization to release medical information / Consent to treatment:
I hereby assign ALL medical benefits to which I am entitled to: Rand Speech Pathology doing business as The Joshua Tree LLC in the event that they file insurance on my behalf. I understand that I am financially responsible for all charges whether they are paid or not by said insurance. I accept responsibility for the principal amount owing as well as all reasonable costs associated with the collection of this debt. Including but not limited to collection service fees, attorney fees, and all court cost and additional fees associated with the recovery of this debt. Interest may be charged at a rate of 8% per month for unpaid balances over (90 days old). I thereby authorize said assignee to release all information necessary to secure the payments of said benefits a copy of this assignment shall be considered as effective and valid as the original. I do herby consent to such treatment by the authorized therapy staff of Rand Speech Pathology doing business as The Joshua Tree LLC as may be dictated by prudent medical practice by child’s illness, injury or condition. This consent is interned as a waiver of liability of such treatment excepting acts of negligence. By signing this form, I authorize Rand Speech Pathology doing business as The Joshua Tree LLC and it’s billing agent, MedBill Solutions, LLC to release my child’s requested medical records to my insurance company, Medicaid, and/or other HIPPA compliant companies to obtain payment for services rendered to my child.