OUR POLICIES & PROCEDURES
Financial and Privacy Patient Forms
Financial Policy
Thank you for choosing us as your health care provider. In order to serve you better we require that all patients read and sign our financial policy. It is your responsibility to understand whether your provider is In-Network to maximize your benefits. We will be glad to assist you on any questions you may have. Click here to download Financial Policy
HIPPA Notice of Privacy Practices
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Click here to download HIPPA Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement
Click here to download HIPPA Notice of Privacy Practices Acknowledgement
Patient Registration and Insurance Information
Click here to download Patient Registration and Insurance Information
Insurance Plans
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AETNA (all products except IPA’S, KelseySeybold IPA & AEXCEL) Affordable American Medical Security Amerihealth Beech Street Benefit Planners CappCare ChoiceCare Cigna (PPO/Open Access Plus/EPO/Indemnity)
Choice Fund OA Plu Cigna Care Network Cigna/Health Partners Employers Plan Services First Health Network- Coventry Health Care John Hancock (CostCare) Health Net HHPO Humana PPO Choice Care/ PPO Humana Preferred PPO/POS/& Humana Preferred OPEN ACCESS Humana National POS-Open Access |
Medicare MHHNP Network: Participation Agreement Affiliated HealthplanBCBS PPO/POS (NO BLUE CHOICE SOLUTIONS) Freedom Of Choice PPO HealthSmart EPO/PPO IMS Interplan HealthGroup Multiplan PPO NHA PPOnext ASSURANT (formly PHCS) Provider Select PPO Texas True Choice Trisurant National Health Care Alliance (also known as American) Preferred Health Network TRS Care TrustMark United Healthcare (All Products including Pacificare signature elite only) United Medical Resource |
Please be aware that this may change, and that we may contract with some insurers for their ppo, but not their HMO or other product. This list may also change without notice; please confirm with us at the time of your appointment your insurance if you desire to utilize in network benefits. We do see many patients out of network or on a cash basis if you so desire. Please contact our billing department if you have questions.