Forms & Insurance


 

CARDIAC CARE CONSULTANTS

For your convenience, we have various forms and instructions for you to download to your computer. Thereby if you are a new patient, you can print out and fill out any necessary forms in the Welcome Package below and bring them with you to your first visit. If you are visiting us for a test, please find the appropriate testing instructions for you in the links below.

WELCOME PACKET FORMS

1) Privacy Practices Notice
2a) Notice of Assignment of Benefits 
2b) Notice of Privacy Practices
3) Patient’s Medical History & Physical 

RECORDS RELEASE FORMS

RECORDS RELEASE FORMS
1a) Release of records TO Cardiac Care Consultants
1b) Release of records FROM Cardiac Care Consultants to another physician

TESTING INSTRUCTIONS

1) Stress Study 
2) Vascular Study 
3) Nuclear Stress Study 
4) Nuclear Stress Study with DOBUTAMINE Infusion
5) Nuclear Stress Study with LEXISCAN Infusion

INSURANCE BILLING

We accept most major insurance plans and accept Medicare assignment.

For a list of insurance companies that we accept, please see below.
For insurances not listed, please contact our office.

ACCEPTED INSURANCES

Aetna Commercial
Aetna Medicare Advantage
Allwell Medicare Advantage- AHCCCS
Ambetter- Marketplace Health Plans
AmeriBen
Arizona Complete Health-AHCCCS
Arizona Foundation for Medical Care
Banner Health Network Plans- Commercial and Medicare
Banner University Health Plans-AHCCCS
BeechStreet Network
BCBS AZ- Commercial
BCBS AZ Medicare Advantage
Care1st-AHCCCS
CHAMPVA
Cigna Commercial
Cigna HealthSprings- Medicare Advantage
CorVel PPO Network
Coventry Health Care
Devoted Health Plan- Medicare Advantage
First Health Network
Fortified PPO Network
Galaxy Health Network PPO
GEHA-Aetna Signature Administrators Network
Gilsbar Incorporated (BCBS)
Great West PPO/POS/Open Access
HealthSmart Complete PPO
Humana Commercial
Humana Medicare Advantage
Imperial Health Plan- Medicare Advantage
Medicare
Mercy Care Plan AHCCCS
Molina Complete Care of AZ-AHCCCS
Multiplan Network
PHCS Network
Prime Health PPO Network
Railroad Medicare
SCAN Desert Health Plan
Three Rivers Provider Network PPO
Tricare Prime/Standard
United Healthcare Commercial & Medicare Advantage
UHC Community Plan- AHCCCS
USA Managed Care PPO
VA- CCN

24-HOUR NOTICE POLICY

Please provide 24-hour notification if you are unable to keep your appointment.

Our Locations

Choose your preferred location