Click Here for Patient Enrollment Form
New Patients are always welcome.
Review your Insurance Provider List and make sure that our clinic and doctors are accepted by your insurance.
*If you do not have insurance or we do not take your insurance, we can give you a diagnoses and care on a case by case basis. Call to discuss this.
As a new patient, it is best to download the Patient Enrollment Form from this website, complete the form, and then bring it with you when you come to the office.
MAKING AN APPOINTMENT:
After you check your Insurance Provider List and determine that your insurance will accept our clinic and doctors, then you should call and make an appointment. Be sure to have your insurance cards available when you call.
WHEN YOU ARRIVE FOR YOUR VISIT:
Plan to arrive 15 minutes early to get your enrollment information set up and to verify your insurance. Check in at the front desk and check to see if there are any more forms you need to fill out. You will need to sign the Notice of Private Practices Acknowledgement.
Be sure to bring these documents with you:
Your insurance card
A government issued ID (Driver’s License)
Your current medications (or an accurate list that includes dose and frequency of use)
Registration and history forms you filled out ahead of time (they are available on our website for you to download and complete before you arrive)
PAYMENTS AND INSURANCE:
Our office policy requires that the fee for services be paid at the time of your visit. This includes co-pays deductibles, and additional fees not ordinarily covered by insurance. Have your insurance card handy because we will need to verify it every visit. You may pay with:
MasterCard or Visa. We do not accept Discover.
We will file your claim for your insurance. Once your insurance calculates the actual charges, they will send you an Explanation of Benefits or “EOB” detailing your processed claims and any amount that was not covered. Some health plans only make these statements available online, so be sure to check your health plan documentation.
If after your claims processes you still owe Dr. Butka’s Clinic a balance, we will send you an account statement by mail. You can pay your balance by:
Credit card over the phone
Mail a check to our office along with your statement
Payment in person
The relationship between you and your personal physician has always been a private confidential matter, and we recognize the trust you have placed in us to keep your information secure. We have an extensive written policy regarding the HIPAA privacy rules that you may review while you are here or take home. We will also ask you to acknowledge that we have told you about this.