AES Financial Policy
Arizona Endocrine Surgery's financial policy outlines your responsibilities and our policies, and it serves as a mutual agreement upon your signature.
By signing this document, you agree to the following:
I agree to provide requested medical records, test results & imaging reports for AES to determine the appropriateness of my condition for specific services.
I agree to provide my insurance coverage details, copy of my insurance card and ID, and any related information requested by AES who will work with my insurance provider in order to obtain prior authorization where applicable.
I recognize that my appointment is not confirmed until I have received specific confirmation of date and time via email or phone, and that my initial appointment time is subject to change.
I understand that I may be required to pay out of pocket for certain in-office procedures, consultations and/or follow-ups for which I will be informed.
I accept that I am responsible for maintaining updated details of my condition, insurance, and contact information at all times.