Patient Forms
Forms
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Advance Beneficiary Notice – English
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Advance Beneficiary Notice – Spanish
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Financial Agreement
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Recurring Payment Authorization Form
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Release of Medical Records
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Medication Update
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Notice of Privacy Practices
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Sleep Lab
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Sleep Study Cancellation Policy
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PFT Instructions
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STOP-BANG Scoring Model
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PSG Instructions
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PAP Check Up
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Cross Border Sleep Study Scheduling Form
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AM Questionnaire
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PM Questionnaire
Insurance Plan Participation
AARP
AARP Medicare Complete
Aetna
AmeriBen IEC Group
APIPA
Bankers Life Insurance
Beech Street
Blue Cross/Blue Shield
Blue Cross Blue Shield Advantage Plan
Blue Cross Blue Shield Federal Employees
Broadspire
Carpenters
Cenpatico
Champus
CIGNA
Cochise Health System
Compass Cooperative Mutual Health Network
Coventry Health
Energy Employees Occupational
Evercare
First Health
FISERV Health Wausau
GEHA
GHI
Great West
Health Choice
Health Choice Generations
HealthNet
AARP Medicare Complete
Aetna
AmeriBen IEC Group
APIPA
Bankers Life Insurance
Beech Street
Blue Cross/Blue Shield
Blue Cross Blue Shield Advantage Plan
Blue Cross Blue Shield Federal Employees
Broadspire
Carpenters
Cenpatico
Champus
CIGNA
Cochise Health System
Compass Cooperative Mutual Health Network
Coventry Health
Energy Employees Occupational
Evercare
First Health
FISERV Health Wausau
GEHA
GHI
Great West
Health Choice
Health Choice Generations
HealthNet
Humana
IBEW First Health
IHS AHCCCS
Indian Health Services
Lifewise Health Plan
Mail Handlers
Medicare
Merritus Health Plan
Mutual of Omaha
ODS
PacifiCare
Pascua Yaqui Tribe
Principal
Private Health Care System
QTC – A Lockheed Martin Company
Railroad Medicare
Secure Horizons
Stratose PPO Network
Transamerica
Tricare
Tri-West
UMR
UFCW
United Health Community Plan
Unicare
Universtiy Care Advantage
Universal Healthcare
University Family Care
VA Medical Center Tucson
Web TPA
WPS VACCA
YOEME
IBEW First Health
IHS AHCCCS
Indian Health Services
Lifewise Health Plan
Mail Handlers
Medicare
Merritus Health Plan
Mutual of Omaha
ODS
PacifiCare
Pascua Yaqui Tribe
Principal
Private Health Care System
QTC – A Lockheed Martin Company
Railroad Medicare
Secure Horizons
Stratose PPO Network
Transamerica
Tricare
Tri-West
UMR
UFCW
United Health Community Plan
Unicare
Universtiy Care Advantage
Universal Healthcare
University Family Care
VA Medical Center Tucson
Web TPA
WPS VACCA
YOEME
We Do Not Accept the Following Insurance:
Allwell Ambetter
Blue Cross Blue Shield HMO – Focus Network
Blue Cross Blue Shield HMO – Pima Connect Network
Blue Cross Blue Shield PPO – Alliance Network
Care First (AHCCCS)
Carelon
Caremore
Health Choice Essentials
IFP – Individual Family Products
Megallion/Molina (AHCCCS)
Mercy Care
Obama Care
Oscar
Phoenix Health Plan
United Healthcare – Navigate
Wellpoint
This list is subject to change. If you are unsure whether your insurance is in-network with us, please email your insurance information to info@pimalung.com. Thank you.