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(1) release any medical or other information necessary to insurance carriers regarding my illness and treatments;
(2) obtain necessary medical records from current and previous treating physicians to determine medical necessity for eligible services;
(3) verify and obtain medical benefits, as well as, submit insurance claims generated in the course of services received from this provider.
I also authorize STILL ME INC, FITTING DESIGNS INC, STILL ME MEDICAL to appeal any unfavorable decisions determined by my insurance carrier which may result in claim denials or nonpayment on my behalf.
I acknowledge that I have been offered the Notice of Privacy Practices.