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Fees & Insurance

The doctors serve as specialty consultants for the following health plans (inquire about others):

  • Blue Cross PMD
  • HealthStrategies
  • VIVA
  • Healthsprings of Alabama
  • Health Choice
  • United Health Care
  • Private Health Care Systems
  • Aetna
  • Cigna
  • SelectCare
  • Seniors First

 

Please bring your health insurance card(s) so we may verify coverage and photocopy them for our records.

Fees:
The office is on a cash basis and fees for non-emergencies should be paid at the time service is rendered. If you are covered by a plan that pays office services, you are responsible at the time of service only for the applicable co-payment.

If your plan requires an approval or precertification for our care, we must have this approval available to us at the time of your visit.

If your insurance company requires filling out a special form, attach the portion of the billing slip you will receive at the time of your visit to your insurance form and mail directly to the company. This provides all the information needed to complete the claim and payment will thus go to you directly.

Information regarding fees for office and hospital services is available upon request.

The surgical fee covers all routine post-operative care and clinic visit; please do not miss post-op checkups because of anticipated increased financial burdens.

Visa, MasterCard and DISCOVER cards are accepted.

Insurance Information:
Payment for services rendered is to be made as follows:
"I request that payment of authorized insurance benefits be made to Richard W. Waguespack, M.D., PC, for any services or items furnished me by the physician or supplier.  I authorize medical information about me to be released to the Health Care Financing Administration (HCFA), my Insurance Carrier, and/or its agents any information needed to determine these benefits or the benefits payable for related services.  I am financially responsible for appropriate deductibles, co-payments, and non-covered items (which have been explained to me from information supplied by my carrier). 
If this account has to be turned over to an attorney due to delinquency or nonpayment, I will be responsible for all costs of collection including the court costs and reasonable attorney fees."

 _____________________________________________________           ________________
 Signature of Beneficiary or Person Signing for Beneficiary                                                Date Signed
 _____________________________________________________            ________________
 Street Address, City, State, Zip of person signing for Beneficiary                                         Relationship
 Reason Beneficiary is unable to sign________________________________________

Dissemination of Medical Information:
To whom may we, as your health care providers, release information about your medical condition(s)?

 ______________________________________________             ________________
                                                                                              Relationship
 ______________________________________________             ________________
                                                                                              Relationship
 ______________________________________________              ________________
                                                                                               Relationship


 ______________________________________________               ________________
 Signature of Patient or Responsible Party                                                              Date Signed

Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment.

 
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