Fort Worth Texas Gastroenterology

For Patients

Office Appointments

You may eat normally that day.  Please bring our paperwork completely filled out along with a list of all medications you take, both prescription and those that you purchase over the counter.  You will also need your current insurance card and driver’s license (or other photo identification). If you do not have paperwork, please arrive 30 minutes early in order to complete it before your appointment.

Patient Forms

New Patents - Please complete, print and bring with you to your appointment. 

Appointment Forms

Endo Medication List

No-Show/Cancelled/Rescheduled Appointments

If you are unable to keep your scheduled appointment time, please call our office at least 24 hours in advance. You are allowed to reschedule an appointment up to three times.

After hours and Weekend Calls

If you are having a medical emergency, please call 911 or go to the nearest emergency room.  Our physicians are on staff at the Texas Health Resources Alliance Hospital.  There is a physician on call 24 hours a day, 7 days a week for urgent calls.  Non-urgent matters will only be handled during regular business hours (Monday – Thursday, 8:00 a.m. – 5:00 p.m. or Friday 8:00 a.m. – 3:00 p.m.).

Prescription Refills

Please contact your pharmacy to request all of your prescription refills even if your prescription does not indicate there are any refills remaining.  All prescriptions are done electronically usually within 24 hours of the request.  In order for some prescriptions to be refilled, you may be required to complete lab work or schedule a follow up visit with the physician.

Medical Records Release Forms

All forms must include an authorization from the patient in order for records to be sent to another office, insurance company, etc.  Once a completed form is received, it will be forwarded to Healthmark for processing.

Disability Forms/FMLA Forms

There is a minimum fee of $25.00 per form completed for patients with a qualifying condition. 


Billing and Insurance

BILLING – OFFICE VISITS

SELF-PAY/NO INSURANCE – Fees are due in full at the time of service.  Cash, check, money order, cashier’s check, American Express, Visa, Mastercard and Discover are all acceptable forms of payment.

INSURANCE – We will file claims with insurance companies that we have a contract with for covered services.  Your insurance will be verified prior to your appointment so that we can tell you what portion of the fee you will be responsible for paying at that time.   This will include all co-pays, unsatisfied portion of the deductible and co-insurance.

BILLING – PROCEDURES

SELF-PAY/NO INSURANCE – all of our services are discounted to the lowest possible rate.  In order to receive this reduced rate, the service must be paid in full at least two days prior to the scheduled procedure date.

INSURANCE – We will file your insurance companies that we are contracted with for covered services.  You will be responsible for any co-pay, unsatisfied portion of the deductible and co-insurance two days prior to the scheduled procedure date.

We schedule procedures at facilities with dedicated endoscopy suites with state of the art equipment.  We currently schedule procedures at:

North Richland Hills Endoscopy Center
Texas Health Alliance ASC
Texas Health Alliance – Out-patient Hospital
Medical City Alliance – Out-patient Hospital

There are many aspects to the billing of these procedures.  You will receive separate bills for the facility, physician, anesthesiologists, nurse anesthetists and pathology.  Our current affiliations with these facilities limit us from assisting you with questions that may arise during the billing process.

The North Richland Hills Endoscopy Center is a joint venture between our parent company (DHAT) and AmSurg,  If you have any questions about billing at this facility, we would be able to direct you to someone within our company to answer your questions.

CONTRACTED INSURANCES

  • Aetna – HMO, PPO, POS, EPO, Open Access. 
  • We do not contract with Aetna Medicare or Aetna Whole Health.
  • Blue Cross/Blue Shield – HMO, PPO, POS, EPO, PAR, Blue Advantage HMO
  • Cigna – HMO, PPO, POS, EPO, Open Access, Local Plus, Bronze & Silver, HealthSpring
    Galaxy Health Network – PPO
  • Healthsmart – PPO, EPO, POS, GEPO
  • Imagine Health/Smartcare – EPO
  • IMS – Independent Medical Systems –PPO
  • Medicare
  • Medicaid – only if secondary to Medicare
  • Multiplan – Beechstreet Network, PHCS, Texas True Choice
  • Scott & White – Limited plans, please check with your individual carrier for participation
  • Tricare – Tricare for Life Only
  • United Healthcare – HMO, PPO, POS, EPO, Secure Horizons, NTSP, WellMed, UHC AARP

REFERRALS

Some insurance plans require a referral from your primary physician in order to see a specialist.  Without this referral, your insurance will not pay any portion of the bill.  If we have not received the proper referral documentation before your scheduled appointment time, you will be given the option to pay in full or to reschedule the appointment. 

 

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