For Patients

To expedite the patient intake process, we provide the following forms to be completed prior to your initial visit to Southwest Orthopaedic Surgery Specialists, PLC. These new patient forms are available in Portable Document Format (PDF). We encourage all new patients to download, print, and complete this paperwork to save time. Bring the completed forms with you to your first appointment.

The following forms can be downloaded to your computer and printed from the convenience of your home or office. By completing these forms before your appointment, you will save time and “speed up” the intake process. The PDF file sizes are relatively small and will take only a few seconds to download, depending on your modem and connection speed.

• Patient Information Record
• Notice of our Privacy Practices
• Consent to Release Medical Records

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These downloadable PDF forms require Adobe Reader for viewing and printing. If you don’t have Adobe Reader, click the following link to download and install this free utility. Get Adobe Reader.

How we Protect your Health Information

Southwest Orthopaedic Surgery Specialists, PLC places the utmost importance on protecting the health information of our patients. Each time you visit the actual clinic of Southwest Orthopaedic Surgery Specialists, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, and treatment plans.

Although your health information becomes the physical property of Southwest Orthopaedic Surgery Specialists, the information belongs to you. Understanding what is in your record and how your health information is used helps you to ensure its accuracy. You should understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others. See our Privacy Policy for more details.

Your First Appointment

Your first appointment at Southwest Orthopaedic Surgery Specialists is an important meeting that can be most effective if you plan ahead. It’s important that you provide the information needed and that you understand what is being recommended. For your first appointment, it is helpful to have copies of your medical records and x-rays if available, a list of medications taken, a summary of your medical history and prior treatments, and a list of your concerns and expectations.

Advanced and Effective Orthopedic Treatment

At Southwest Orthopaedic Surgery Specialists, every patient receives the most caring, advanced and effective orthopedic treatment possible. Involvement of the patient at any step of the decision-making process is regarded as crucial in determining the type and timing of orthopedic treatment. We are committed to creating an environment in which patients not only receive effective orthopedic treatment, but also compassionate personal care. Contact us with any questions or concerns you may have regarding your health, orthopedic treatment or interest in our practice.

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Payment and Insurance

Payment is the responsibility of the patient and the patient’s insurance company for charges resulting from services provided by Southwest Orthopaedic Surgery Specialists, PLC. Our fees have been aligned with Medicare’s Resource Based Relative Value Scale and geographically adjusted for orthopedic specialists serving the southern Arizona region. If we are contracted with your insurance company, we will abide by their payment schedule.

Accepted Forms of Payment

Southwest Orthopaedic Surgery Specialists accepts cash, checks and most major credit cards for payment. If we have a contractual agreement with a patient’s insurance carrier, a claim will be filed and payment will be settled according to the insurance plan.

Contracted Insurance Plans

Southwest Orthopaedic Surgery Specialists, PLC is contracted with Medicare, Blue Cross / Blue Shield, Arizona Workers Compensation and several other insurance carriers. In some cases, we may submit claims to other primary insurance companies. Please contact us should you have any questions regarding your health insurance coverage.

If we do not have a contract with your insurance carrier, we will not accept their non-contracted payment rates or their definition of “usual and customary.” We may send you (the patient) a statement and expect payment in full. We will be happy to assist by providing any additional claim information that your insurance company may request.

Medicare

Our physicians are participation providers with Medicare, and we will file your Medicare claims for our services. We do not expect any payments from you until after Medicare has processed your claims. If you have secondary insurance, those claims will also be filed for you.

Workers Compensation

Southwest Orthopaedic Surgery Specialists is contracted with in-state Arizona Workers Compensation. We require that you provide us with your workers compensation claim number, the name of your carrier, the date of injury, your employer at the time of injury, and the part of body that was injured. Without this information, your claims cannot be filed, and you would be held responsible for payment.

Co-Payments

The patient is responsible for paying any insurance co-payments at the time of service as specified in his or her insurance policy. If your insurance carrier pays at a limited percent, we request that you pay your portion of the services on the date that you receive services.

Please call Southwest Orthopaedic Surgery Specialists in Tucson, AZ at (520) 327-9677, if you have any questions or problems with payment or insurance. We are happy to answer your questions and assist you with arranging payment for our orthopedic services.