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Huntsville Alabama online Form 4506-A: What You Should Know
The program has to be filled and submitted using a Credit or Debit account that has not been opened by the patient. Crestwood Medical Center (CMC) may not discount to the extent that they are required by the IRS to discount. The customer can obtain the following types of discounts from CMC. Dental Insurance — A 30% Discount from the standard dental plan fee, up to a maximum of 50.00 per child. Emergency Dental — A 60% discount from the standard dental plan fee for minor and major emergencies including but not limited to, dental surgery, dental extractions and emergency dental care up to a maximum of 175.00 per child. Out-of-pocket Medical — A 90% discount from the standard dental plan fee for minor and major emergencies, including but not limited to emergencies such as a dental emergency, severe toothache/dentures, emergency dental care, hospital care, and emergency care for major illnesses. This program is available from all CMC dental facilities. A maximum of 400.00 per child can be paid off with annual payments up to the maximum of 300.00. It does not include services provided in connection with dental procedures. Mental Health Care Insurance — CMC is unable to discount this type of insurance because they are required by law to discount to the extent that they are required by the IRS to discount. Please check with your health insurance provider for any discounts on these services. All discounts provided are valid from date of purchase and expiration date of the policy. To get an estimate of the amount of discount you may qualify for, write your name on the paper work and provide the amount of the discount on a copy of the form. A 50.00 discount is available annually for each child of any age. A 75.00 discount is available annually for each child of any age. A 300.00 discount is available annually for each child of any age. Please refer to Your Medical Coverage Policy for more details. In-House Discounts — This can not be purchased, but must be requested by the patient. If you can obtain another type of discount or discount on any other type of insurance, please call the office of your health insurance company. Purchased Services Offered For Patient Discounts — No additional services will be provided. No charges may be collected for any services used with a discount from a discount plan.
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