I understand that Melanie Conway, MD is a non-participating provider of services at this office for commercial or government (Medicare/Medicaid) insurance plans.  I understand that Dr. Conway does not bill insurance on my behalf, but a receipt for services will be presented to me at the time of service so I may bill my insurance company personally.  I understand that by hitting Submit, I will be certifying that I am financially responsible for any and all charges relating to the treatment of myself/the patient at the time services are rendered.