Forms
Patient Forms Made Easy
Skip the stress on appointment day. Download and complete your forms ahead of time at home. It’s a simple way to save time and help us serve you faster so you can focus on what matters most—your health and your family.
New Patient Packet
Family Release of INFORMATION
HIPPA AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION
NOTICE OF PRIVACY PRACTICES
Protection
Insurance Coverage
In Network with Most Insurances
Family Medicine of White Hall is dedicated to providing you with the highest quality, cost effective medical care. Please remember to bring your insurance card and a photo ID with you on every visit.
As a courtesy to our patients, we will submit insurance claims to the insurance company directly. However, patients are responsible for these charges. The insurance policy is a contract between the insurance company and the patient. We are not a part of that contract. If you are covered by insurance, your co-payment, deductible and non-covered charges are expected at the time of service along with any past due balance. You will be required to pay your authorized portion of the bill at the time services are rendered unless payment arrangements have been approved in advance by our staff.
Common Health Insurance Terms and Definitions
To help you better understand health insurance, this is a list of some commonly used health care terms and definitions. This is not a full list. These terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any such case, the policy or plan governs.
NETWORK
The doctors, hospital, and suppliers your health insurance company has contracted with to deliver health care services to their members.
PREMIUM
The amount you pay for your health insurance or plan each month.
CO-INSURANCE
Your share of the cost for a covered heath care services, usually calculated as a percentage (like 20%) of the allowed amount for that service.
OUT OF POCKET
Your expenses for medical care that aren’t reimbursed by your insurance. Out of pocket costs usually include deductibles, co-insurance and copays for covered services plus all costs for services that aren’t covered.
PCP
Primary Care Provider or Primary Care Physician
Your health care needs are coordinated by the provider you select as your PCP. Some insurance companies require you to select a PCP and only receive care from that provider unless you have a referral.
COPAY
A fixed amount ($25, for example) you pay for services provided by a covered health care provider. You may still owe deductible and/or co-insurance after you've paid your copay.
DEDUCTIBLE
The amount you owe for covered health care services before your health insurance plan begins to pay. This can include the physician, shots, x-rays, labs, procedures, etc.
Compassionate Care Starts Here
See why patients across White Hall and Pine Bluff trust us to deliver the kind of care that feels personal and lasting.