Insurance Disclaimer
If co-payments and/or deductibles are designated by my insurance company or health plan, you agree to pay them to The Women's Image Center. The Women's Image Center will be authorized by you to release any information required to process any and all claims for reimbursement. You also understand that if a referral was obtained, that this is not a guarantee of payment and you will be responsible for any charges denied by your insurance and/or health plan.



