Financial Responsibility Agreement

 I understand that my insurance is a contract between me and the insurance carrier, and not between the insurance carrier and Washington Nephrology Associates, and that I am still fully responsible for all fees.  Should timely payments of this account not be made, I authorize Washington Nephrology Associates to retain the services of an attorney and/or collection agency to assist with the collection of only outstanding balance.  Any expenses incurred by such action shall become an additional liability for which I assume responsibility.