Patient Forms
- Acknowledgment of Info Sheet
- Authorization to Release Healthcare Information
- Consent for Use and Disclosure of Protected Health Information (PHI)
- Facility Assignment of Benefits
- In-Network Disclosure
- Medical Records Release
- Notice of Privacy Practices
- Office Policies
- Patient Demographics Sheet
- Patient Financial Responsibility Statement
- Patient Medication Sheet
- Patient Rights Summary Sheet
- Patient Registration Form
- Patient HIPAA Consent Form
Anesthesia Information
Procedure Preps
- Colonoscopy
- General Colonoscopy Instructions
- 1A-Miralax Dulcolax Prep clear liq
- 1B-Miralax Dulcolax Split Prep clear liq
- 2A-Citrate Miralax Dulcolax clear liq
- 2B-Citrate miralax dulco Split 2021
- 3-Extended double Citrate miralax dulco Splitclear liq
- 4A-OSMO prepclear liq
- 4B-OSMO Split prep clear liq
- 5-2 DAYCitrate Miralax Dulcolax Prepclear liq
- 6-2 DAY miralax Dulcolax Prepclear liq
- 7A-Citrate Dulcolax 2021 clear liq
- 7B-Citrate Dulcolax split clear liq
- 8A-Citrate Miralax Prepclear liq
- 8B-Citrate miralax splitclear liq
Endoscopy
FAQ’s
Insurance / Billing
Our Endoscopy Centers strive to give the best patient care possible, from start to finish. This includes having our patients informed so they do not incur unnecessary costs. We know how complex the healthcare system has become and would like to make things a little bit easier.
It is also important to contact your insurance company because there are so many different plans that have different levels of coverage. To find out what out-of-pocket costs you may be responsible for you should contact your specific plan. The facility might be in-network but there could be a deductible, co-payment, or co-insurance that you are not aware of.
Below is a list of Insurances we are in- network with, however there are many different plans within each insurance.
- Medicare
- Horizon Blue Cross and Blue Shield
- Aetna
- Oxford
- Cigna
- US Healthcare
- United Healthcare
- and many others.
Please check with your insurance company to see whether we are listed as a participating provider. For all billing questions please call our office.