This contract is being signed by and between ________________________ and POST&CLAIM MEDICAL CODING AND BILLING, LLC. This contract has been made effective date _________________ [effective date of contract agreement] and shall remain into effect until __________________ [date of termination of contract agreement]. Official Name: POST&CLAIM MEDICAL CODING AND BILLING, LLC. Address: P.O. BOX 3211, Paterson, NJ 07509 Email address:
[email protected] CONSUMER CONTACT & HEALTH INSURANCE PORTAL LOGIN NAME: EMAIL: ADDRESS:
USERNAME:
CONTACT NUMBER:
PASSWORD:
Terms and Conditions of the contract:
POST&CLAIM will advocate on behalf of the consumer to dispute medical claims with consumer’s health insurance carrier, healthcare professional and utilizing consumer health insurance portal login access. POST&CLAIM is committed to follow-up with all medical claims to ensure claim resolution. Consumer understands during the evaluation period there is no guarantee an error will be identified. Payments are non-refundable even when no errors are identified. Payment is required once POST&CLAIM identifies an error. POST&CLAIM shall receive a fee of 15% of the amount saved on the medical bill. Example: Consumer saves $125 and will pay P&C $18.75. There will be no fee to the consumer for medical claims savings under $30. Per New Jersey State Law your healthcare professional (s) can charge consumers a fee for requesting copies of their medical record. Search fee $10, $1 per page copied, postage 15% of record copying costs and certification fee $10. Per New Jersey State Law hospitals will charge consumers an admission search fee of $10 per patient per request. Although the patient may have had more than one admission, and thus more than one individual admission record is provided, only one search fee shall be charged for each request per patient. The search fee shall apply even if no individual admission record is found as a result of the search. A fee for certification of a copy of a medical record of $10 per certification. A patient or patient’s legally authorized representative shall have the right to receive a full or certified copy of the medical record. If payment is not received from the consumer, POST&CLAIM will discontinue it’s service of the claim with the healthcare professional(s) or insurance carrier(s). The contract shall be terminated if consumer does not comply with payment agreement above once medical claim error has been identified. Consumer may terminate the contract at any time prior to the processing of the claim. Consumer must notify POST&CLAIM of termination by email at kmpostandclaim.com. Please sign if all terms and conditions of the contract are understood and agreeable. Signatures:
_______________________________ [Signature of Consumer]
Date:_______________________
_______________________________ [Signature of Second Party] Date:_______________________
POST & CLAIM | P.O. BOX 3211| PATERSON, NJ 07509 | (973) 742-1349 |
[email protected]
