DWEB-CMS2A
About Mercy

Proof of Coverage

At the time of registration, you will be asked to provide either your current insurance company card or information about your current insurance company. In addition, please furnish any specific forms or original documentation (claim forms, authorizations, referrals, etc.) required by your insurance company.

Mercy will bill your insurance carrier if you have provided us with all necessary policy information. In the absence of necessary billing information, you will be responsible for payment of your entire account.

During the registration process, you will be asked to sign an Assignment of Insurance Benefits form. This form allows Mercy to file your medical claim with your insurance carrier and have your carrier make payments directly to Mercy. Please read this form carefully. The registration staff will be happy to answer any questions regarding its content.

Mercy files your insurance claim as a courtesy service. However, you are ultimately responsible for paying for the services provided.

 

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