Save time by printing and completing forms at your convenience. The documents below provide important information about your rights as a patient and the Center. Please review carefully prior to your procedure date.

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Patient Forms

Patient Admission Forms
Patient Appointment Info-Blue Aspen Plastic Surgery
Patient Financial Responsibility
Privacy Statement
Release of Medical Records Request

Northwest accepts a wide variety of insurance plans, including the following major providers:

CONTRACTED

Aetna
Aetna Medicare Advantage
Beech Street (and Viant)
CIGNA/Great West
CMN
Cofinity
Concentra
Corvel
Coventry / First Health
GEHA
HMN
Humana
Humana Medicare Advantage
Integrated Health Plan
Medicare
Medicare Railroad
MultiPlan PHCS
United Healthcare / Pacificare / Secure Horizons /

Your financial responsibility at the time of service will be any co-pay/deductible and/or co-insurance. You will be balance billed for any services and/or charges not covered by your insurance plan. As a courtesy to you, we will bill your insurance.

Our Center will contact you regarding your insurance coverage and expected charges. Generally, all insurance carriers, including Medicare, reimburse outpatient centers just as they would other health facilities. Standard charges have been established for all procedures performed at Northwest Regional Ambulatory Surgery Center.

OUT OF NETWORK

Blue Cross Blue Shield
Colorado Access
Humana HMO Select (HCA employees)
Rocky Mountain Health Plan
Kaiser
Medicaid (we can see secondary Medicaid only- no primary)
We offer out-of-network patients in-network rates

• Please bring your insurance card(s), any related forms you might have and a personal identification card.
• If you are a Medicare patient, make sure you bring your Medicare card with you.
• If you are represented by an attorney, please bring his or her name, address and phone number.

If you are a self-pay patient, we require that you pay for your service on or before the date of your appointment, unless other arrangements have been made. We accept VISA, MasterCard, American Express and Discover.

We will bill your insurance on your behalf; however, anything not covered by your insurance will be your responsibility to pay. If you have questions about financial arrangements, please call us at (303) 328-3400.

We at Northwest will do our best by working with you to make appropriate financial arrangements; however, these arrangements must be finalized before the date of your appointment and approved by our Administrator. Please call us at (303) 328-3400 with questions or for additional information.

• Patient Forms
• Insurance and Payment