Forms & Insurance

1) Patient Information
2a) Financial Policy 
2b) Notice of Patient Information Practices
3) Patient’s Medical History & Physical 

1) Balance Billing - Surprise Bills 

Please provide 24-hour notification if you are unable to keep your appointment.

Aetna Commercial
Aetna Medicare Advantage
Allwell Medicare Advantage- AHCCCS
Ambetter- Marketplace Health Plans
Arizona Complete Health-AHCCCS
Arizona Foundation for Medical Care
AZ Care Network Plans (ACN)

• Aetna HMO, POS and PPO plans
• Cigna Local Plus and Sure Fit
• UMR- Dignity Health Employees
• Intel Connected Care
• Bright Health- Medicare Advantage and Commercial plans
• Mercy Care
• BCBS Tenet Employees
• UHC- Navigate and Nexus network
• New 2022 plans ---- Alignment Healthcare- Medicare Advantage, Medica Exchange plans, Aetna Medicare Plan & Employers Health network

BCBS AZ- Commercial
BCBS AZ Medicare Advantage
Bright Health Plan
Care1st-AHCCCS
Cigna Commercial
Cigna HealthSprings- Medicare Advantage
CorVel PPO Network
*Equality Health Network** 2022

• BCBS Medicare Advantage Blue Pathway Plan 1 and BCBS Blue Pathway 2
• Devoted Health Plan- Medicare Advantage
• Imperial Health Plan- Medicare Advantage
• SCAN Desert Health Plan- Medicare Advantage
• BCBS Federal Healthcare Exchange- BCBS Maricopa Focus Health plan

Fortified PPO Network
Galaxy Health Network PPO
GEHA-Aetna Signature Administrators Network
Health Choice- AHCCCS
Health Choice Generations- AHCCCS Medicare Advantage plan
Health Smart Complete PPO
Humana Commercial
Humana Medicare
ICP Health Plans

• Aetna Medicare Advantage
• Banner Aetna
• Blue Cross Blue Shield Alliance
• Blue Cross Blue Shield Medicare Advantage
• Cigna Local Plus
• Devoted Health Medicare Advantage
• Honor Health Employee Plan
• Humana Gold
• Oscar
• United Healthcare Medicare Advantage

Medicare
Mercy Care Plan AHCCCS
Molina Complete Care of AZ-AHCCCS
Multiplan Network
Prime Health PPO Network
Railroad Medicare
Three Rivers Provider Network PPO
Tricare Prime/Standard
United Healthcare Commercial & Medicare Advantage
UHC Community Plan- AHCCCS
USA Managed Care PPO
VA- CCN