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ASSIGNMENT OF BENEFITS / FINANCIAL RESPONSIBILITES15211 Cortez Blvd, Brookville, FL 34613 Phone: (352) 3454565 Fax: (352) 5966061 Dr. Alonso and Dr. ZavitsanosTodays Date: ___ Dr. Benson and Dr. KerrPatient
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01
Obtain the assignment of benefits form from Browning Insurance.
02
Read and understand the instructions on the form.
03
Fill in your personal information, such as your name, address, and contact details.
04
Provide your insurance policy information, including the policy number and effective dates.
05
Indicate the name of the medical provider or facility you are assigning benefits to.
06
Specify the date or duration of the assignment.
07
Sign and date the form to authorize the assignment of benefits.
08
Make a copy of the completed form for your records.
09
Submit the assignment of benefits form to Browning Insurance via mail, fax, or electronic means.
10
Keep a proof of submission or confirmation for future reference.

Who needs assignment of benefitsbrowning insurance?

01
Anyone who wants to authorize their medical provider or facility to directly receive insurance payments on their behalf needs assignment of benefits from Browning Insurance.
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Assignment of benefits is a document signed by a policyholder that allows a third party, such as a contractor or medical provider, to receive payment directly from the insurance company for services provided.
Policyholders who wish to have a third party receive payment directly from the insurance company are required to file an assignment of benefits form.
To fill out an assignment of benefits form, policyholders must provide their information, the third party's information, details of the services provided, and sign the document.
The purpose of assignment of benefits is to streamline the payment process by allowing third parties to receive payment directly from the insurance company.
The assignment of benefits form must include the policyholder's information, the third party's information, details of the services provided, and the policyholder's signature.
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