Forms For Download
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1. Patient Information Sheet
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2. Patient Personal History Form
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3. Financial Policy
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4. Standard Consent for HIPAA
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5. Notice of Privacy Practices

To view the PDF forms, you will need to have Adobe Reader installed on your computer. If you do not have the software already installed on your machine, you can download it from Adobe's Web site by click on the icon below.



INSURANCE BILLING
Will you bill my insurance?
Because Capitol City Cardiology, Inc. participates with most major insurance plans, as a courtesy, we will file an insurance claim for you. Patients should be prepared to present a current health insurance card at the time of each office visit. If you have secondary insurance, please provide us with that insurance information as well. It is your responsibility to provide current, accurate insurance information, address and phone numbers at the time you receive medical services.

Our billing staff will make every effort to collect the maximum benefits due, based on the type of insurance you have.

If you are newly enrolled with your commercial carrier, you can request a verification of benefits document from your employer. You must bring this information with you at the time of your visit. Our staff will call your insurance carrier to verify eligibility dates and services.

If your insurance plan requires a co-payment, you will need to pay that amount at the time of registration.

You will be asked to pay any personal balance if our records indicate you have received a statement and have not made a recent payment or have failed to contact the billing office to make payment arrangements.

If you do not have an insurance card, or, your Medicaid application is “pending” at the time of registration, you will be considered “self-pay.” Payment will be expected at the time of your visit. The office staff can provide you with our fees.

How will I know if I have a co-pay?

If your insurance contract requires that you pay a co-payment for office services, it will be clearly printed on your insurance card. Some policies require their subscribers only pay a co-payment for office visits. Others require a co-payment for each encounter. Since policies vary widely, please contact your carrier if you have any questions about your co-payment obligation.

Our staff is trained to review your insurance card closely and collect the co-payment shown on your card, but your preparation ahead of time will “insure” no surprises.

How may I pay for my medical service?

We accept payment by Cash, Check, VISA or Mastercard.

INSURANCE PLANS
Is my insurance plan honored at your office?
We suggest you always double-check your insurance coverage when scheduling an appointment with a new physician. Capitol City Cardiology, Inc. contracts with most major carriers – just ask us if yours is one of them when you call for an appointment.

Call your provider representative if you need clarification on your coverage. The provider relations number is located on the back of your insurance card. We encourage you to be an informed consumer!

If you have any questions, please contact our billing department
at 614-722-7960, or toll-free at 800-479-8802 option #5.

 



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