If you are planning to visit Green Country Podiatry, download and fill out our Patient Information Form (90k PDF) to save time on your visit! If this is your first visit, please be sure to fill out the Initial Visit page.
Note: This interactive PDF document contains editable fields; you may fill it out on your computer, print it out, and sign it!
As a receipt for your payment, we will supply you with a superbill, this will list your treatment and our fees. We accept assignments and participate on many insurance plans. If your plan is an HMO, it is your responsibility to assure a referral from your primary care physician prior to your visit. Should you decide to pursue treatment, without this the charges incurred will be your responsibility. If your plan is not one which we are contracted, you are responsible for payment at the time of service. Any questions regarding your insurance should be directed to our business office prior to treatment.
In an effort to help prevent Identity theft we are now following the AMA suggested guidelines, regarding the new Red Flag Rule, as required by the FTC. This means that we will request to see Identification for all new patients, which include: drivers licenses or other photo ID, current insurance cards, and if the ID provided does not show current address, we will request a utility bill or other correspondence showing current residence. We will also take a photograph to be placed with your medical records.
We are not contracted with Medicare, but we are happy to see and treat Medicare patients, however, the bill will be the patient's responsibility. Our business office will submit the claim to Medicare for reimbursement to the patient on covered services.
WE DO NOT ACCEPT WORKER'S COMP.
** All copays, deductibles, and co-insurance are due at the time of services **
*** This list is subject to change. Please check with the Green Country Podiatry office to confirm your Insurer's participation at 747-4855. ***
|
|
