INSURANCE

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INSURANCE

Please bring the following information to your visit, if you have not already faxed or brought this information to the practice prior to your scheduled visit:

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•  Insurance card(s)

•  Driver's license or other photo identification

•  Completed Patient Information form

•  Completed Medical History form

•  Completed HIPAA form

•  Completed Appointment and Balance Due form

•  Completed Financial Policy form

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If you have records from another facility you would like transferred to us for your appointment please complete the attached Release of Information form.

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PAYMENT POLICY

It is our payment policy to collect the appropriate payment due from the patient at the time the service is rendered. This may only be your co-payment, deductible and/or co-insurance, but we do ask for payment at the time of your visit. We accept all major credit cards.

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Co-payment

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The cost-sharing part of your bill that is a fixed dollar amount designated by your insurance company that is your responsibility to pay at each visit (also known as “co-pay”). Common co-payment rates are $10 or $20 per visit, but be aware that co-payment rates vary from insurance company to insurance company.

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Deductible

The amount of cost-sharing that you must pay for medical services often before your health insurance company starts to pay.

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Co-insurance

The part of your bill, in addition to a co-pay, that you must pay. Co-insurance is usually a percentage of the total medical bill—for example, 20 percent.

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INSURANCE COMPANIES ACCEPTED

• Alliance PPO

• Blue Cross Blue Shield – All Plans

• Beechstreet

• Cigna

• CCN

• First Health

• Great West PPO

• Healthcare Savings

• Humana (Choice Care )

• Medcost

• Medicaid

• Medicare

• One Health

• Partners Medicare

• PHCS-Private Healthcare Systems

• Primary Physicians Care

• Southcare – Ethix PPO Tricare (Healthnet)

• United Healthcare

• Wellpath /Coventry