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Learn More About Our Forms And Policies

Here you can find links to our new patient forms, billing and insurance information, and frequently asked questions. Don't hesitate to contact us if you have questions about any of these items.

Download Patient Forms

Before your appointment with us, quickly and conveniently access patient forms from our practice. To view the forms listed below, you need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring completed forms with you at the time of your visit.
Address LocationsAges & Stages Questionnaires Ages & Stages Questionnaires EspañolContent for Use & DisclosureHealth Information ConsentImmunization RegistryNew Patient PacketNew Patient PFSH FormNotice of Privacy PracticesPatient Financial ResponsibilityPEDS Response FormPEDS Formulario Para Respuestas

Insurance Coverage

We participate with most local and many national insurance plans. However it is your responsibility to understand whether your insurance has limits on the doctors you can see, or the services you can receive. If you provide complete and accurate information about your insurance, we will submit claims to your insurance carrier and receive payments for services. Depending on your insurance coverage, you may be responsible for co-payments, co-insurance, or other deductible amounts. Please contact our billing office or call your insurance carrier should you have questions. Many of the services provided by our office are covered and paid by your insurance company. If there is a procedure ordered by one of our providers that is not covered under your insurance plan you will be held responsible for payment.
If your claim is rejected, we will help you in any way that we can in clarifying your claim. We cannot, however, guarantee your claim will be paid as plans vary greatly in coverage offered. In the case of separated or divorced parents, it is our policy that the parent who brings the patient to the office is responsible for payment unless prior arrangements have been made with our business office. Any arrangements between the parents, legal or otherwise, are between the parents and not with Almouie Pediatrics. This is a list of a few insurance providers that we are contracted with. If you do not see your insurance carrier listed please call the member services number on your insurance card to confirm that we are providers.

PARTICIPATING INSURANCE PLANS

  • Aetna
  • Amerigroup
  • Anthem
  • Blue Cross Blue
    Shield
  • Cigna
  • Connecticut General
  • Driscoll Children’s
    Health Plan
  • Fortis
  • FiServ
  • GEHA
  • Golden Rule
  • Great West
  • Guardian
  • Humana
  • Providence Health
  • Spohn Health Network
  • Superior Health Plan
  • Tricare
  • Unicare
  • United Healthcare

Frequently Asked Questions

If you did not find your answer in our FAQs page, please contact our office so that we can further assist you.
Contact Us

If you need prescription refills, please call your pharmacy and let them know what you need refilled. The pharmacy will contact us for the approval. Please notify your pharmacy at least 1-2 days before you complete your medication. Prescription refills on controlled substances i.e., (ADD,ADHD meds) require 24 hr notice, if you fail to pick up your prescription within the time allowed (5 days) a $5.00 charge will apply for any additional prescriptions. All other prescriptions require medical supervision and we will request to see the patient to determine a plan of treatment.

Almouie Pediatrics is a Primary Care facility therefore most specialty appointments must be scheduled by our office. If you feel that your child is in need of a specialist we will most likely ask to see the child to determine his/her needs. If your child requires a follow-up with a specialist please call our office.