Audubon Orthotic & Prosthetic Services 

• Home
• About Audubon OPS
• Our Clinical Staff
• Orthotic Services
• Prosthetic Services
• Insurance Contracts
• Event Calendar
• Contact Us
• Resources
• Financial Agreement
• HIPAA Privacy

While insurance coverage may exist for the equipment provided by Audubon Orthotic & Prosthetic Services (AOPS) to me, I recognize that all equipment may not be covered, or that reimbursement may be less than 100% of charges billed, in accordance with my coverage. Therefore, I agree to be financially responsible for any balance owing on my account including all co-payments and deductibles. Conversely, I understand that AOPS will incur costs associated with ordering or custom fabricating my device and/or supplies, and therefore I agree to be financially responsible for these charges. These charges may include, at AOPS discretion, the entire cost of the items. In addition, I agree, unless I am a Medicare recipient and AOPS has accepted assignment or I am a Medicaid recipient, to immediately pay the full amount due to AOPS if (a) no payment is received by AOPS within 30 days from the date AOPS submits a claim, or (b) my physician or I fail to provide AOPS with information necessary to submit the claim. I agree to transfer immediately to AOPS any payment made directly to me for equipment provided by AOPS on an assigned basis. I agree that should AOPS decline to accept assignment of my benefits from Medicare or any other payer, I will pay the full amount due to AOPS.