Patient Information

New Patient

Thank you for choosing Crystal Canyon ENT & FPS as your health care provider.

About Your Visit

Please bring the following items to your initial consultation:

  • All insurance cards
  • Photo ID
  • Completed new patient paperwork
  • If you are the guardian of a minor, bring all guardianship paperwork
  • List of medications you are taking
  • Copy of XRAYS, CT scans and any other applicable reports

Additional information for your office visit:

  • Please arrive 15 minutes prior to appointment time.
  • Co-payment is due at every office visit and the specific amount is indicated on your insurance card. If you have any questions regarding co-payment, we recommend contacting your insurance provider.
  • Arriving late to your appointment may result in your appointment being rescheduled.
  • We will make every effort to accommodate your scheduling needs. In return, we ask that you notify us at least one business day in advance if you need to reschedule your appointment.

Paciente Nuevo

Gracias por elegir Crystal Canyon ENT y Cirugía Plástica Facial como su proveedor de cuidado de la csalud.

Acerca de su Visita
  • Favor de traer los siguientes elementos para su consulta inicial:
  • Todas las tarjetas de segura
  • Identificacion
  • Terminado el papeleo nuevo paciente
  • Si usted es el tutor de un menor de edad, traer toda la documentación de tutela
  • Lista de medicamentos que está tomando
  • Copia de rayos X, tomografías computarizadas y cualquier otra
Información adicional para los informes correspondientes de su visita a la oficina:
  • Favor de llegar 15 minutos antes de la hora programada.
  • Co-pago es debido en cada visita al consultorio y el importe específico se indica en su tarjeta de seguro.
  • Si usted tiene alguna pregunta acerca de co-pago, se recomienda ponerse en contacto con su proveedor de seguros.
  • Si usted necesita ayuda o un traductor, por favor traiga persona adecuada para su cita. Llegar tarde a su cita puede resultar en la cita se ha aplazado.
  • Vamos a hacer todo lo posible para acomodar sus necesidades de programación.
  • A cambio, le pedimos que nos notifique por lo menos un día hábil de anticipación si necesita cambiar su cita.

Download new patient paperwork here.

Para el papeleo del paciente nuevo por favor haga clic aqui.

Notice of Privacy Practices for Protected Health Information. Click here.

Insurance Participation*

We are contracted with the following insurance providers. Some insurance companies require a referral or authorization before being seen by a specialist. Contact your insurance provider for more information.

  • Aetna
  • Administrative Enterprises
  • Ameriben
  • Asbait
  • Assurant Health
  • AZ Benefit Options
  • AZ Foundation
  • Banner
  • Beechstreet Corporation
  • Blue Cross Blue Shield
  • Capstone (AHCCCS)
  • Champ VA
  • Cigna
  • Coventry Health Care
  • GEHA
  • Gilsbar
  • Great West
  • Health Choice (AHCCCS)
  • Health Net
  • Humana
  • IHS Contract Health
  • Indian Health Services (AHCCCS)
  • Key Benefit Administrators
  • Medicare
  • Mutual of Omaha
  • Navitus
  • Pacificare
  • Phoenix Health Plan (AHCCCS)
  • Secure Horizons
  • Tall Tree Administrators
  • Tricare
  • UMR
  • United Health Care
  • Universal Health Care
  • Zenith

*Though we make every effort to keep insurance participation up-to-date, please contact our office to confirm if we are contracted with your insurance provider.

Billing Policies & Procedures

  • Co-payment is due at the time of service. Not following this requirement could result in the termination and cancellation of medical coverage for patient.
  • It is the patient's responsibility to make sure that his/her doctor is in network for private insurance plans.
  • It is the patient's responsibility to make sure all hospital procedures and/or testing is pre-approved by the carrier. As a courtesy, our office will assist in obtaining pre-approval. However, pre-approval does not guarantee payment and all patients are expected to know their benefits and coverage under their specific insurance plan.
  • We accept Medicare assignments. All Medicare patients need to have a referring physician from the State of Arizona for initial consultation. Failure to do so may result in denial of payment.
  • Any deductibles, co-payments, and/or charges not paid by the carrier are the patient's responsibility.
  • Payment for privately paying patients is due upon service(s) rendered.
  • The Billing Office files claims for all carriers with whom we participate. Payments by the insurance carriers will be made directly to our office. They will provide you with an Explanation of Benefits (EOB) of the charges, amount covered by your policy, and payments made to our office on your behalf. Your insurance may or may not allow a portion of your bill at which time the remaining balance is your responsibility. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier.
  • As a courtesy, the Billing Office also files claims to carriers with whom we do not participate. Payments by the insurance carriers may be sent directly to the patient instead of our office. It is the responsibility of the patient to remit payment to our office at the time of service in these cases. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier.
  • Some insurance companies require co-payments for allergy injections. As a courtesy to our patients, all services provided in the office or at the hospital will be billed to your insurance company. Most insurance companies require two or three months to process a claim. If we are not a contracted provider for your insurance company, you will be responsible for any charges that exceed the payments we receive from your insurance carrier. We DO NOT accept reasonable and customary payment as payment in full for those insurance companies for which we are not contracted.
  • In the event of default on payment toward account balance, collection fees, interest, court costs, and reasonable attorney's fees will be the patient's responsibility.
  • For your convenience we accept the following methods of payment: cash, debit, check, Visa, Discovery and Mastercard.