By checking the box and typing your name below, you authorize RomiCare to:
- Review the bills, insurance documents, and other materials you upload for this case.
- Analyze your billing and insurance information against RomiCare's standard assessment methodology.
- Contact you to request additional information or documentation needed to complete this assessment.
For this Phase 1 service, RomiCare's deliverable is a written assessment. This authorization does not, by itself, direct RomiCare to contact your healthcare provider, insurer, or any billing administrator on your behalf. If a future service adds that capability, a separate, specific authorization will be presented before RomiCare does so.
You confirm that:
- You are the patient named in this case, or you have the legal authority to act on the patient's behalf (e.g. as a parent, legal guardian, or authorized representative).
- The information you provide is accurate to the best of your knowledge.
You understand that:
- RomiCare provides bill review and information, not medical, legal, or insurance advice.
- RomiCare cannot guarantee any specific outcome, correction, or reduction to your bill.
- This authorization can be revoked at any time by contacting RomiCare, effective for work not yet performed.