For your initial visit, all patients or their guardians will be asked to download and complete New Patient Forms and bring these with you to your appointment.
Please bring a complete list of medications you are taking, including dose and frequency.
View the Medications guidelines below.
Please arrive at the office 15 minutes prior to your scheduled time. The first visit
is very thorough so plan to spend at least two hours in the office. Follow-up appointment required. (Date to be determined after 1st visit).
We look forward to helping you manage your allergy and asthma symptoms.
Fees for services vary based on the level of care and testing provided. The office visit and skin tests run approximately $750-$900, any lab tests would be additional. Depending on which type of insurance or whether your deductible has been met, a payment of $200.00, the insurance co-pay, or 20% of the charges is required.
Notice Informing Individuals about Nondiscrimination
Patient Satisfaction Survey
Release of Medical Records FROM the Asthma & Allergy Center
Consent to Treat Minors
Welcome Letter
Initial Visit
Payment Policy
Patient History
Patient Agreement
Patient Information
Insurance Information
Notice of Privacy Practices
Research Opportunities
You may continue all asthma medications, nasal steroid sprays and oral decongestants such as Sudafed.
NOTICE: Certain prescription medications will interfere with the skin tests and these include tricyclic antidepressants (e.g. Elavil, Phenergan, Antivert and Vistaril). If you cannot safely discontinue this medication 7 days before your visit, simply let us know that you are taking this medication when you come for your appointment
If you are in a managed care plan, the referral from your Primary Care Physician must list the following procedures:
We accept cash, check, Visa, Master Card, American Express and Discover/Novus. If you are in a managed care plan, your office co-pay is due at the time of your visit. Statements are mailed out on a monthly basis.
If you have met your deductible, your copay is due at the time of
your visit as well as any outstanding balance on your account. If your deductible has not been met, a minimum payment is required.
Depending on which type of insurance or whether your deductible has been met, a payment of $200.00, your office co-pay, or 20% of the charges is required.
Cancellation/No Show Policy: We request 24 hours (1 business day) notice
to cancel or reschedule office visits. This allows us to fill our schedule
with another patient. If you cannot keep your appointment and do not provide
sufficient notice, you may be charged a $40 fee. Fees must be paid before
your next appointment. Arriving late for an appointment may require you to
reschedule.
Allergy injections start at 8:00 a.m. Monday through Saturday. Once you recieve your allergy injection you must be able to stay in the office for 30 minutes.
The Asthma & Allergy Center accepts Medicare, Medicaid, Tricare and all major insurance providers.
We will submit your charges to Medicare for you. We adjust any difference between our charge and the Medicare allowance. You are responsible for your deductible and 20% of Medicare’s allowance. If you are enrolled in a managed care plan for Medicare, a referral from your primary care physician will be needed.
All patients eligible for Medicaid Benefits must have a current Eligibility Card at the time of each visit. The Nebraska Health Connection Identification Document is necessary for those assigned to a managed care plan. Please inform us if you are covered by any other type of insurance.
Please bring in your military ID card with you to your initial visit. As Tricare providers, we will submit your charges for you. Those with Tricare Prime must have a referral from your primary care physician.
As a convenience, we will file your insurance claim to your main insurance plan and any secondary/supplemental plans. Feel free to call our office if you have questions about participation in an insurance plan. It is very important that you keep us updated on any changes in your personal information.
