Accepted Insurance Providers

Which Insurance Providers Cover Certain Gastrointestinal Procedures?

Dr. Alexander Mantas participates in the Accepted Insurance Plans listed below. Please call his office if you do not see your Insurance Plan as this list expands every month and may not be up to date. If Dr. Mantas does accept your Insurance, please verify your eligibility and benefits and find out the following about your specific plan before your visit.

Insurance Checklist

If Dr. Mantas And His Facilities Are “In Network”
If Dr. Mantas Is At Your Preferred Tier Level
Your Annual Deductible
Your Office Visit Co-Payment (Due At The Time Of Your Appointment)
If A Referral Is Required
Need For Pre-Certification
Presence Of Co-Insurance

After your visit and/or procedure, your Insurance Provider will send you an “Explanation of Benefits” that will explain how your bill was paid and any amount for which you may be responsible. The following may be billed to you and your Insurance Provider – Physician Fee, Lab Fee, Facility Fee, Pathology Fee and Anesthesia Fee.

Some Insurance Plans require you to pay different out-of-pocket amounts based on the location where the service is performed. Deductibles, co-insurance and co-payments may also apply according to your Insurance Plan. By law, you are responsible for these amounts, as well as any non-covered services outlined in your health plan. We will submit primary, secondary and tertiary claims on your behalf as long as the information needed to process the claim is obtained and verified before your visit. If this information is obtained after your visit, the patient or guarantor is responsible for the balance.

If you have any questions, need assistance or do not see your Insurance Provider listed, please call our office.

Accepted Insurance Plan Details

Aetna

Blue Cross and Blue Shield

Cigna

United Healthcare

Other: Baylor Scott & White Plan, WellMed, Humana, Care-N-Care, Imagine360 (formerly GPA), Sa-Na Benefits, UMR

Disclaimers

I understand that if any of the insurance information I have provided is incorrect or if I fail to notify the office of any insurance changes that I am responsible for all physician charges and non-covered medical services.

I hereby authorize the release of any medical information necessary for the process of insurance. I hereby assign all medical and/or surgical benefits to include major medical benefits to which I am entitled to Alexander Mantas, MD, PA, Digestive Health Associates of Texas, PA and Digestive Health Management Endoscopy Centers. This assignment will remain in effect until revoked by me in writing. A photocopy of this agreement is to be considered as valid as an original. I have received the Notice of Privacy Practices.

By Submitting This Form, Patient Agrees To All Terms, Conditions & Disclaimers!

Security Question

1+1=?

Accepted Insurance Providers

Which Insurance Providers Cover Certain Gastrointestinal Procedures?

Accepted Insurance Providers

Which Insurance Providers Cover Certain Gastrointestinal Procedures?

Insurance Checklist

Accepted Insurance Plan Details

Aetna

Blue Cross and Blue Shield

Cigna

United Healthcare

Other: Baylor Scott & White Plan, WellMed, Humana, Care-N-Care, Imagine360 (formerly GPA), Sa-Na Benefits, UMR

Appointment Request

Full Legal Name

Gender

Date of Birth

Email Address

Home Phone Number

Mobile Phone Number

Office Phone Number

Prior GI Work Up

Select Requested Procedure(s)

If Yes, please briefly describe your work up including all previous procedures and their dates and the gastroenterologist who treated you.

Referring Doctor (If Self Referral, Please Type "Self")

Primary Care Doctor

Primary Insurance Provider

Reason For Office Visit

Disclaimers

By Submitting This Form, Patient Agrees To All Terms, Conditions & Disclaimers!

Security Question

Translate: