Patient Forms & Payment Info

patient forms and payment info, new patient paperwork, insurance, hippa privacy policy, sleep questionnaire, sleep disorder center questions

To save you time, we've provided the forms (PDF format) you will need to fill out when visiting our office. Please print the forms, complete them, and bring them with you to your next appointment.

New Patient Paperwork

HIPPA Privacy Policy/Release

Sleep Questionnaire (for new sleep referrals)

Sleep Disorder Center Instructions

Release of Information

-To Eastern Pulmonary & Sleep Medicine, P.C
-From Eastern Pulmonary, Sleep & Allergy, P.C

Billing & Insurance Policies

paying for services, filing insurance claims, medicare patients, hmo, managed care insurance plans, eastern pulmonary and sleep medicine, p.c., birmingham, al

Paying for Services
Eastern Pulmonary, Sleep & Allergy, P.C accepts most major insurance plans, cash, checks, money orders, Visa, MasterCard, and Discover. Payment is due at the time services are rendered. Please come prepared to pay all or a significant portion of your patient balance (insurance deductibles, co-payments, etc.).

Filing Insurance Claims
Our business office will file your primary and secondary insurance for you. Please bring your insurance card(s) and all information needed to complete forms. We file your insurance as a courtesy to you and are eager to help you receive the maximum allowable benefit from your carrier; however, we need your active participation in the insurance claims process. If your claim is not paid within 45 days, please call your insurance carrier to find out why it has not been paid. After 90 days, the balance may be considered your responsibility.

Depending on your type of medical coverage, specific conditions and procedures may be required. It is important to consider the information listed below that relates to your coverage.

Medicare Patients
As a participating provider of Medicare Part B (Physician Services), we will only collect your Medicare coinsurance and/or deductible at the time of service, unless you have a secondary insurance. All other services will be billed electronically to Medicare. If you have Medicare Part A only, then the services you receive from our practice will not be covered by Medicare, which means you will be financially responsible.

HMO/Managed Care Insurance Patients
Many HMO/Managed Care plans require that you obtain a referral in order to receive care from a specialist. Please be certain you have an authorization number for office visits or any other services that are scheduled for you. Without an authorization, your insurance company will not pay their preferred benefit and could hold you financially responsible for the services you receive. It is to your advantage to make sure you have an authorization number prior to your visit. Some of the insurance companies that require referrals are BCBS Personal Choice, BCBS-AHC, Medicaid and HealthSprings.

Eastern Pulmonary, Sleep & Allergy, P.C
100 Pilot Medical Dr. #100
Birmingham, AL 35235
Office: 205-854-8084
Fax: 205-815-9341
Billing/Insurance Line: 205-815-2458
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