On your initial check in, the usual paperwork will need to be filled out:
• Patient History & Physical Data
• Patient Contact Information
• Patient Insurance
• Patient Contact Authorization Form
• HIPPA Acknowledgement
To see what information you will need, you can downloaded them from here.
If you would like to save yourself a little time before your appointment,
please download, print and fill out the forms, and bring
them to your first appointment. But please note,
do not sign them until they have been reviewed by our staff.
If you have any questions or concerns over one of the questions, leave it blank and ask our staff when you arrive, or please feel free to contact us.
Patient Insurance Checklist
As patients approach surgery, they frequently need information regarding insurance benefits. As a courtesy to our patients, we would like to inform you of several things that are important to you when having any procedure that involves your insurance company. It is the patient’s responsibility to check on the following:
- If your insurance requires that you have a referral from your Primary Care Physician (PCP), you must obtain the referral by calling your PCP. Please verify that both physician(s) and Meridian Plastic Surgery Center are contracted with your insurance company. This is especially important if you have an HMO policy. If we are not a network provider for you, please verify if you have out-of-network benefits.
- If your procedure is going to require anesthesia at the Meridian Plastic Surgery Center, you will need to know if your insurance requires you to use a specific group. The group that we use is North Side Anesthesiologist Service, LLC. Billing for North Side Anesthesia is handled by Susan J. Taylor Billing Service at phone number (317)567-2179. You should ask to speak to Jamie Malone at (317)614-9627. Hours for the billing service are 8 am – 5 pm Monday through Thursday and 8 am – 2:30 pm on Friday.
- The Meridian Plastic Surgery center uses Ameripath of Indiana Laboratory for any pathology testing. If you are having procedures that will require pathology testing, you will need to verify that your insurance company will accept this lab. The telephone number for Ameripath is (317)275-8112 or 1-866-635-1917.
In order for our facility to give you the most information regarding your insurance benefits, you must supply us with your most current insurance card(s) with the billing address (es) and phone number(s).
It is our goal to help you get the maximum benefits from your insurance company, but your failure to follow through with the above information could result in denial of coverage and cause your benefits to be waived. If you have a deductible that has not been met, you may be responsible for payment at the time of service. Please keep in mind that your insurance contract is between you and your insurance company making it your responsibility to know your benefits.
Please be advised that the average waiting period for insurance benefit information is 7-14 working days. The average waiting period for predetermination for approval on small procedures is 8-12 weeks. The process can vary with different insurance companies. Please contact Brenda Brouillard (317)663-7217 with any questions or concerns you may have regarding precertification, predetermination, or insurance benefits.