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Note: The responsible party is the individual the bill should be sent to.
Although you may have medicare and insurance benefits, there is no guarantee of payment. While we will be responsible for billing your primary insurance and although we may assist you in billing your secondary insurance, your agreement with your insurance company is between you and them. Lasata will expect payment in full of all coinsurance and non-covered services upon your receipt of the billing statement. To continue the pre-admissions assessment and evaluation, please complete the information below. Please Check the most accurate range below.
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