ENGLEWOODPATIENT INFORMATION
Forms, insurance information, and a few things to remember for every appointment.
START HERE
Registration, privacy consent, financial policy, medical records authorization, cancellation policy, and health history.
Complete the forms and bring them to the front desk with your photo ID and insurance card(s).
LECOM
New patient
registration
YOUR INFORMATION
YOUR HEALTH HISTORY
YOUR FIRST VISIT
THINGS TO REMEMBER
15
minutes early
every appointment
There is always something to sign and confirm at check-in, even if you checked in online. We need to get you back to the room and ready to see the doctor, and that takes time. Your appointment time is with your provider, and that 15 minutes gives us time to update information, take vitals, welcome you to your visit and ask a few questions. Please do not ask for an exception to this.
Insurance is tricky, and we do our best, but we focus on your healthcare and ask that you know your insurance so there are no surprises. Insurance will never guarantee coverage until they get a claim and review it, so please be aware of that nuance. Also, check for out-of-network benefits, in-network benefits, deductibles, copays for specialists and co-insurance.
INSURANCE
Verify your coverage: Your insurance policy is a contract between you and your insurance plan. We strongly recommend contacting your insurance company before your visit to confirm your specific benefits and ensure your FDHS provider is in-network.
Bring your ID: Please bring your current insurance card(s) and a photo ID to every appointment. This ensures we have the most up-to-date information to submit claims on your behalf.
Accepted insurance plans: While we participate with many insurance plans, coverage can vary by specific plan and location.
Aetna
Blue Cross Blue Shield
Cigna
Multiplan and PHCS
First Health
UnitedHealthcare
Railroad Medicare
Traditional Medicare
Tricare
Aetna
HealthSpring (formerly Cigna)
UnitedHealthcare, including Dual Complete
WellMed
Please call the office about specific network participation. Coverage is specific to your policy and is not guaranteed by an insurer name alone.
PRACTICE INFORMATION
Patients are responsible for paying co-pays, co-insurance and deductible payments. For your convenience, we accept most major credit cards and checks. Effective January 1, 2020, we will no longer accept self-pay patients. LECOM Englewood Family Practice does not accept auto accident related claims.
Please provide at least 24 hours’ notice to cancel or reschedule. A $25 fee applies to missed appointments or cancellations within 24 hours and is charged to the patient, not the insurer.
Use the authorization in the packet and ask your previous provider to fax records to (941) 473-3583. The practice cannot accept medical records on disk.
As providers who participate in Medicare, we will file claims for you. As per Medicare’s guidelines, you will be responsible for a 20% co-insurance once you have met your annual deductible. We will also file with your secondary insurance plan unless you inform us that you do not want us to.
If your insurance plan requires a referral or pre-authorization before your visit or treatment, please confirm that your insurance provider or primary care physician has fulfilled the necessary requirements before your appointment. If not, you may be responsible for the entire cost of the visit or procedure.
If we do not participate with your insurance, you are responsible for charges at the time of service. We will still prepare and send an unassigned claim to your insurance company so it can reimburse you directly. If a service is deemed “non-covered” by your plan, you will be responsible for the full charge upon receiving our statement.
LET’S GET YOU SCHEDULED