Patient Hub

Patient Rights and Protections Against Surprise Medical Bills If you have private health insurance, there are protections in place that provide visibility to your planned medical charges and fees when requested. If you’re uninsured or you decide not to use your health insurance healthcare services, under these protections, you can often get a good faith estimate of the cost of your care up front, before your visit. Patients who are uninsured or who choose not to utilize insurance coverage for medical services have the right to request a good faith estimate for the total expected costs prior to receiving care. For cash-pay patients, a breakdown of costs for any tests or procedures beyond the overall medical visit charge are shared at the time of the visit. You can request a paper copy of this estimate from our office at any time. We will also keep a copy on file in your patient chart for future reference if need be. If the bill you receive is at least $400 more than your good faith estimate, you can dispute the charges. You have 120 days from the date on your bill to do so. For questions or more information about your rights under the ‘No Surprises Act’, visit www.cms.gov/nosurprises.

Currently we do not participate with the Medicaid insurance. Sorry for the inconvenience. We are more than happy to see any patients that do not have insurance coverage. If your insurance is not listed below, please contact our office.

AARP
Aetna
Avmed
BCBS
ChampVA
Cigna
GHI
Golden Rule
Humana
Medica
Medical Mutual
Medicare
Railroad Medicare
Secure Horizons
Tricare
UMR
United Health Care

Patient Information and Forms

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Arriving for your appointment

Patient Forms

Medical Release Form

Medical Release Form

Medical Release Form

Patient Intake Form

Medical Release Form

Medical Release Form

Minor Consent Form

Medical Release Form

New Patient Registration Form

New Patient Registration Form

New Patient Registration Form

New Patient Registration Form

Established Patient Form

New Patient Registration Form

Established Patient Form

HIPPA Privacy Practices

New Patient Registration Form

Established Patient Form

Surgery Pre-op Instructions

Surgery Post-Op Care Instruction

Surgery Post-Op Care Instruction

Surgery Post-Op Care Instruction

Surgery Post-Op Care Instruction

Surgery Post-Op Care Instruction

Blue Light Pre-Therapy

Surgery Post-Op Care Instruction

Blue Light Pre-Therapy

Blue Light Post-Therapy

Blue Light Post-Therapy

Blue Light Pre-Therapy

Biopsy Post-Op Care

Blue Light Post-Therapy

Biopsy Post-Op Care

Insurance We Accept

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