Assignment of Benefits

I agree to assign any right I may have to receive payment from a health insurance plan or other payor(s) for services rendered by Arizona Joint Specialty Center and the physicians caring for me during my treatment. I understand that I am financially responsible for all balances that are not covered by my health insurance plan or payor, as appropriate, based on the terms of contracts or the law. For example, the payment of non-covered services, deductibles and co-payments are considered to be the patient’s responsibility. I also understand that I am financially responsible for collection costs should my account become delinquent.