Forms / Insurance / Billing
- Insurance Card(s)
- Picture identification
- Information about any health care providers or tests you might have seen or received since your last visit with us, for better care coordination.
- Current Medication list with dosage, strength, etc.
- Previous test results
- Required Co-Pay, Deductible or Co-Insurance
Also, please be prepared to share your medical history with our staff. You may be asked questions about any current medical conditions you have or may have had in the past; previous surgeries, family history, any medications (whether prescription/RX or over the counter/ OTC), or allergies you may have to foods or medications.
If you are unable to keep an appointment, please call the office at least 24 hours in advance to reschedule so as to give other patients who need help a chance to be seen.
We are affiliated with Piedmont Clinic and Piedmont Hospitals and accept the same insurance plans. If you do not see your plan below or have a question about your specific plan, please call your physician’s office or call your insurance company.
- Aetna PPO/HMO/EPO
Beech Street PPO
Blue Cross Blue Shield HMO/PPO/PAR
First Health PPO
Great West HMO/POS/PPO/OPEN ACCESS
Humana Medicare Advantage/HMO/PPO
- Medical Mutual of Ohio PPO
Private Health Care
Tricare Prime HMO
Tricare Standard PPO
PLEASE NOTE: The amount of your co-pay, deductible or co-insurance is determined by your health insurance company. It is NOT a number that your physician’s office sets or changes arbitrarily. These payments are required by your insurance company and are due at time of service. We accept cash, checks, debit cards and all major credit cards (AMEX, VISA, MASTERCARD, DISCOVER).
Forms (click to open)
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