48-Hour Cancellation Policy
For each Medical-Legal appointment the provider reserves an extended amount of time in their schedule to spend with the injured worker. Prior to the evaluation, the provider also reviews past medical records. Finally, this office complies with the the obligatory appointment notifications.
For these reasons, if the injured worker fails to show up for the evaluation, or to cancel or reschedule this medical-legal evaluation by the date noted in the table above, a missed appointment fee will be charged as follows:
ML 100 $500.00 - Missed Appointment for a Comprehensive or Follow-Up Medical-Legal Evaluation.
By signing below, you agree to honor this cancellation policy and to reimburse the provider the amount above should the injured worker fail to show up at the scheduled appointment or to cancel or reschedule by the date noted in the table above.
Please sign and fax this cancellation to the following fax number: ________________ .
Signature: Print Name:
Was this article helpful?
DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.
Drop us a line with any news you would like us to share or any issue that concerns you.