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Co-insurance and the deductible are based upon the charge determination of the Medicare carrier. Name Medicare Policy Financial Contract Agreement Ophthalmology Consultants Ltd is committed to your successful treatment. I understand the provider does not accept reimbursement of expenses allowable under my insurance plan and authorize payment directly to the provider for services rendered. I understand I will receive a monthly statement for any b.

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  • musculoskeletal
  • 2003
  • 00AM
  • COINSURANCE
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