YOUR VISIT

Here’s everything you need to know to get the most out of your visit to Upper Cumberland Urology.

WHAT TO BRING

You should bring the following items with you to your next office visit in order to accelerate the check-in process and assist the provider with your medical care. You need only bring those items that apply to you.
 

  • Current list of medicines you are taking (prescription and over-the-counter)

  • A copy of the CD or films of any X-rays, MRIs, CAT scans, etc. that you have had

  • Current insurance card(s)

  • Driver’s license or other picture ID

  • Copy of power of attorney, if applicable

  • Co-pay and/or deductible, if applicable

  • Forms you completed from our web page

  • A list of questions you want to ask the provider when in the room with them.


You can view our privacy practices here

We accept most major credit cards, debit cards, cash, and personal checks.

INSURANCE

Insurances Accepted as of 1-1-2018
Please note: This list is subject to change. Please contact your insurance provider at the number on your card in order to verify your eligibility for our services.

 

  • Aetna Insurance Company

  • Blue Cross Insurance Company

  • Bluegrass Family Health Network

  • CIGNA Insurance Company

  • Coventry Group Health Network

  • First Health Network

  • Healthspring

  • Humana Network

  • Medicare Part B

  • Medicare Advantage Plans: Blue Cross, Aetna, and Humana

  • Multiplan Network

  • Private Healthcare Systems Network

  • Railroad Medicare

  • TennCare Plans: Select, BlueCare, Americhoice and Amerigroup

  • TennCare State Medicaid

  • Tricare Plans: Tricare Prime, Tricare Standard and Tricare for Life

  • UMWA Retirement Plan

  • UnitedHealthcare

  • UnitedHealthcare Community

  • United Healthcare Dual Complete

FINANCIAL AGREEMENT

UPPER CUMBERLAND UROLOGY ASSOCIATES, PC
PATIENT FINANCIAL RESPONSIBILITY AGREEMENT
ALL PATIENTS


Patients receiving care at Upper Cumberland Urology Associates PC are responsible for their own bill. Payment is expected at the time services are rendered. As with any other business, it is necessary for us to receive payment for the services we provide to ensure we can continue providing these services for you at reasonable prices. We understand most patients today have health insurance coverage. As a courtesy to you, we file insurance claims for each billable service we provide. However, we do not accept responsibility for collecting your claims. Our staff is more than willing to assist you in receiving the benefits you are due, but ultimately you are responsible for your bill, including deductible, co-pay and co-insurance. Payment plans may be available for patients needing to make special arrangements to pay off their bills. These arrangements should be made in advance of receiving services. Please feel free to ask questions and discuss financial matters with any of our patient accounts personnel.

 

  1. Payment is expected at the time of service.

  2. ALL co-pays must be paid PRIOR to seeing the physician or we reserve the right to reschedule your visit.

  3. Payment is necessary to continue providing quality services at reasonable prices.

  4. Insurance is filed as a courtesy.

  5. Our staff is willing to assist you, but you are ultimately responsible.

  6. Payment plans may be available if arranged in advance of receiving service.

  7. We reserve the right to turn patient balances over to collections and/or dismiss patients from the practice for nonpayment.

  8. Payment is expected from the parent with the minor child at the clinic visit, regardless of custody arrangements.

  9. Return check fee is $20.

SELF-PAY POLICY
  • Self-pay patients will be required to pay at the time of each office visit. We will offer a discount for these services.

  • If you have a procedure/surgery done at the hospital or in our office, you will be given the amount of our doctor’s fees and how much money is required for a down payment or payment in full. Payment arrangements may be available.

  • A letter will be mailed to patients seen through the hospital, emergency room, or one of the satellite clinics requesting payment in full or instructing you to call the office to discuss payment arrangements.

  • Payment plans may be available if arranged in advance of receiving service.

  • We reserve the right to turn patient balances over to collections and/or dismiss patients from the practice for nonpayment.

  • Each patient must sign a payment agreement if the account is not paid in full at the time of service.

  • As long as the patient pays according to the payment agreement, no other collection action will occur.

  • If payments are not made according to the Patient Financial Responsibility agreement, then collection will be pursued.

  • A Patient Financial Responsibility agreement explaining this policy will be given to self-pay patients seen in our office.

Please arrive 30 minutes prior to your scheduled appointment.
After hours or in case of emergency call Cookeville Regional Medical Center: 931-528-2541