Forms & Information
Complete and submit New Patient Packet through our
secure portal: Click here
New Patient Packet
Authorization for Release of Information
CCM (Chronic Care Management) Consent
GENERAL BILLING INFORMATION
INFORMATION FOR PATIENTS WITH MEDICARE
Medicare does not cover all costs related to the medical treatment you receive at Nephrology Associates, PA. Unless you provide us with secondary insurance information you will be responsible for 20% of the Medicare allowed amount, as well as the Medicare Part B annual deductible ($233 as of 1/1/2022). If your deductible has not been met you may be asked to pay it prior to being seen.
Medigap policies are secondary insurance policies that help cover the 20% that Medicare does not cover.
Not all Medigap policies are the same: some plans pay everything, including the Part B deductible and all coinsurance amounts so there is no money due from the patient; other plans do not pay the Part B deductible but do cover the 20% coinsurance due; other plans have a copay, usually $20, each time services are rendered.
If you need help understanding what type of Medigap plan you have, or would like more information on the types of plans available to you please feel free to contact our billing office at (501) 663-0490 or click here for more information.
INFORMATION FOR PATIENTS WITH COMMERCIAL
For your convenience, Nephrology Associates, PA participates with most major insurance companies. As a courtesy to you, we will file a claim on your behalf for services rendered to you. Please remember, any amount not covered by insurance is ultimately the patient's responsibility.
You are responsible for copayments, coinsurance, and deductibles depending on your insurance coverage. Nephrology Associates, PA requires that copayments be paid at the time of service. In addition to your copay, you may be asked to pay a portion of your deductible if it has not already been met. You also remain responsible for any balances remaining due to copayment, coinsurance, or deductible.
INFORMATION FOR PATIENTS ON OR STARTING
We encourage all of our dialysis patients to consider their insurance options. Once you reach end-stage renal disease (ESRD), you are automatically eligible for Medicare regardless of your age, as long as you have completed the required number of work quarters.
We have put together a booklet explaining all of your options.
Feel free to contact our billing office at (501) 663-0490 with any questions related to your insurance coverage.
Our physicians oversee the care of patients at the following DaVita dialysis centers:
Midtown (Hemodialysis only)
Central (Hemodialysis, Peritoneal Dialysis, and Home Hemodialysis)
Jacksonville (Hemodialysis only)
Springhill (Hemodialysis and Peritoneal Dialysis)
Sherwood (Hemodialysis only)
Conway (Hemodialysis and Peritoneal Dialysis)
College City - Conway (Hemodialysis)
Saline (Hemodialysis only)
Searcy (Hemodialysis and Peritoneal Dialysis)
Batesville (Hemodialysis only)
Newport (Hemodialysis only)
Click here to learn more about Davita and to find a center.
Dr. David also oversees patients at Fidelity Dialysis.
Any healthcare insurance policy you may have is a contract between you and your insurance company or employer. Nephrology Associates, PA is happy to assist you in obtaining payment from any healthcare insurance policy for medical services rendered at our practice.
For your convenience, Nephrology Associates, PA accepts all major credit and debit cards, personal checks, cashier's checks, money orders, and cash as forms of payment.
Charges for lab tests performed by Nephrology Associates, PA will be included on your monthly statement from our office. Lab tests which are not performed by Nephrology Associates, PA will be billed separately by the servicing facility or provider.
If your insurance requires a referral, it is your responsibility to obtain one prior to your appointment.
Patients with an active bankruptcy case will be required to pay in full at the time of service.
If you do not currently have medical insurance, we will be happy to provide you with a Good Faith Estimate prior to your visit. We ask that you request this from our office no later than three (3) days prior to your scheduled appointment.
Our group accepts the following insurances:
- Medicare, including Railroad Medicare
- Arkansas Medicaid
- Arkansas Blue Cross and Blue Shield
- BCBS Out of State (Bluecard)
- Health Advantage
- Medipak Advantage (Medicare HMO/Replacement)
- United Healthcare
- Humana (Medicare HMO/Replacement)
- Wellcare (Medicare HMO/Replacement)
- Union Pacific
- Allwell (Medicare HMO/Replacement)
- Tricare East
Please see our educational information for information regarding diets, patient instructions, and information about chronic kidney disease. Click here for more information.
Emily Allen, APRN, also teaches a monthly plant-based nutrition course. Contact one of our offices if you are interested in attending this class.