Ancillary Services Request

• The physician’s office staff schedules the appointment for the patient.
• Each client must present a valid HAI ID card to receive ancillary services. If this card is not presented at the time of service the patient will be responsible for the bill.
• All ancillary services are provided free of charge if scheduled through Northeast Georgia Health System. All other services performed outside the NGHS network will be the responsibility of the patient.
• Some professional services have not been negotiated to date. Updated information on professional services will be provided as it is available. Patients will be billed for some professional services. (Example: there will be no charge for a scheduled operation but the client will be responsible for the fee related to pathology if this service is required.)

P.O. Box 907446 | Gainesville, Georgia 30501 | 770-287-0785 | fax: 770-287-0722

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