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Thank you for choosing Mercy Medical Center - West Lakes for your health care needs. There are several important things that you should know about your financial responsibilities.

Registration
At the time of registration, you will have been asked to provide either a current insurance card or information about your current insurance carrier, as well as any specific forms or original documentation (claim forms, authorizations, referrals, etc.) required by your carrier. As a courtesy, Mercy will file your insurance claim, but you are ultimately responsible for paying for the services provided.

Treatment consent

During registration, you will also have been asked to sign a "General Consent for Treatment" form and an "Assignment of Insurance Benefits" form. These forms allow Mercy to treat you as a patient, file with your insurance carrier and have your carrier make payments directly to Mercy. In addition, Medicare recipients will receive a handout entitled "An Important Message from Medicare" that gives important information and lists telephone numbers.

Please note: In the event you are not with your child when an emergency situation occurs, your child cannot receive treatment without your consent. Your written consent is required before your child can receive emergency treatment. To ensure immediate medical attention for your child in your absence, complete an Emergency Treatment Authorization for Minors form (PDF)* and leave it with your child’s caregiver.



* PDF documents require Adobe Reader.

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