Yakima Urology Associates, PLLC

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Important Patient Information

In the interest of providing the best medical service available, we want to be sure our patients are aware of the following:

Incomplete forms could result in rescheduled appointments
Co-Pays and deductibles are due at time of service
We'll gladly bill your insurance company but you are ultimately responsible for timely payment of the bill

Here is a checklist of items for your appointment:

1: Referrals

In some cases, your insurance company requires a referral from your Primary Care Physician (PCP). This is especially true if your insurance is a Health Maintenance Organization (HMO) or Managed Care Plan. Here's how you obtain your referral to see our Urologist:

• Call your Primary Care Provider to request a referral to see the urologist of your choice.
• Have them fax the referral to Yakima Urology 509 573 3324.
• The Business Office will confirm the referral with your health insurance company. The Front Desk Receptionist will notify you regarding your appointment time and date.

• If you have a referral, or your insurance does not require one, proceed to step 2

2: Forms

Please be sure you have the following forms completed and in our office at least one week prior to your visit. If for any reason you have not received these forms, please notify us immediately

• Patient Demographic form
• Credit Policy form: Note that Yakima Urology requires a $100 payment prior to seeing the physician if you do not have insurance coverage. Also, there is a fee for NSF checks
• Medical information form (all pages)

All three of these forms are contained in our Patient Info Packet form linked at the top of the page.

If there are areas on these forms that do not apply to you, please put N/A so we know that you have not missed the question.

3: Medications and Allergies

Please be certain that we have a complete list of all medications you are taking. This is extremely important to avoid duplication or conflict among prescriptions. If there is any doubt as to the prescription information in your medical information form (step 2), please bring the actual medication containers with you, full or empty.
It is also very important that you tell us about any allergies that you have

4: Health information

Please make written notes on any recent heath changes, illnesses, injuries, surgeries and other medical information that is not covered on your medical information form (step 2)

5: Medical records

Please bring any films, X-Rays, CDs, reports, or other information from your primary care physician or hospital. If you are not sure whether or not these are available, ask your primary care provider.

We rely on you to personally obtain these items and bring them with you.

6: Insurance Information and cards

Be sure to bring the following with you:

• All insurance cards
• All information on other insurance you have that doesn't provide a card or coupon
• Medicare card (s) if applicable
• Medicaid coupon or card information if applicable

Please let us know if you are covered by Medicare Advantage, Medicare Managed Care, part C and/or have Medicare Drug Prescription, part D. If you are not certain what you have, please contact our business office prior to your visit and we'll try to help you determine your coverage.

7: Financial preparation

Please come prepared to pay all co pays at the time of service. Co pays are the portion of the payment that your insurance requires you to pay.
If you are a private pay patient, please bring $100.00 for initial payment.
Please be aware that Yakima Urology Associates is happy to bill your insurance company, however you are ultimately responsible for timely payment of the charges regardless of the insurance companies actions.

8: Special requirements

• If this appointment is for a minor, the adult responsible for the minor must accompany the minor.

• If this appointment is for a mentally challenged individual, physically disabled or person requiring extra care, a responsible and knowledgeable individual must accompany

• If appointment is for a nursing home patient, please inform us when the appointment is scheduled. A responsible person in charge of the patient must accompany the patient.

• If you require an interpreter, please let us know when the appointment is scheduled. Your appointment may be rescheduled if an interpreter is not available at the time of your visit.