On your first visit to the Columbus Medical Center, P.C. you will be asked to fill out a patient information form or complete our on-line form.  This is basic information establishing your medical record and business account.  Please bring your current insurance information at that time and notify our office of any changes in name, address, phone number or insurance as soon as any change occurs.

Upon arrival for your appointment, please provide the receptionist with your current insurance card.  A copy will be made and put in your file.

We are participating physicians with the following insurance companies:

For your convenience, we offer the following payment options:

1. Payment in full at time of appointment, if no insurance coverage.  We do accept VISA or MASTERCARD.

2. Payment of the portion your insurance will not cover (co-payment of deductible) on the day service is provided.

3. Payment of balance in full up on receipt of your statement.

If other arrangements are needed, please talk to our business office PRIOR TO receiving service.

Fees:

Our charges for services, including office visits and procedures, are based upon the severity and complexity of your injury or illness.   Our charges are based on requirements under Federal CPT4 guidelines.  Our staff will be glad to discuss our fees with you.

Insurance:

Our business office will submit primary and secondary insurance claims for you, subject to your having given us current information PRIOR to the service being provided.

Policy coverage varies from one insurance plan to another, as do the "Usual, customary and reasonable" fees that various insurance plans have established.  Should there be a dispute related to the service provided or the charge for that service, our clinic will provide supporting documents, but the settlement of that dispute with your insurance carrier is between you and your insurance carrier.  Our office is not involved in the settlement of such disputes.  The final responsibility for the services provided to you is yours.

Medical Records:

Patient medical records are produced and owned by Columbus Medical Center, Inc. The only outside party that may have access to a patient's record is the patient, or, in the case of a minor, the legal custodian. Access by any other party requires the written permission of the patient (or legal custodian).

If you have records that need to be transferred to another physician, you will need to fill out a record release form here in our office or send us a written request to the Columbus Medical Center, P.C., 1454 28th Avenue, Columbus, Nebraska 68601.  Include the names and birth dates of all patients whose records are to be transferred, the name and address of the new physician, a statement requesting transfer, and your signature.  Please allow up to two weeks for the transfer to take place.  We do not transfer records by fax, unless it is an emergency situation.  Only copies of your records are sent.  The original record will remain in our office files.  We transfer records to physicians at no charge.

If a third party such as a life insurance company or a law firm requires a copy of your medical record, their request must include a signed release from the patient (or legal custodian). A $20.00 handling fee will be charged, along with a charge of $.50 per page copied.  Once payment is received, allow up to two weeks for the copy to be sent.

If you have records at another physicians office and want them transferred to us, the same form & information applies.

Please print the Authorization for Release of Information, for your convenience.