What to Bring to Your Appointment

• Your insurance card
• Physician referral forms, if required by insurance
• List of prescriptions and/or over-the-counter medication, including dose and frequency
• Information about your medical and surgical history
• Recent x-rays or relevant records

Insurance and Payment Information

Urology Specialists, P.C., is a provider for Medicare and most major insurance plans, and provides insurance billing. You are responsible for charges that are not covered by your insurance, at the time of your appointment.

Your insurance company may require a co-payment at the time of your appointment. You may also be responsible for a deductible or co-insurance connected to your office visit and/or any procedure you may have done.

If you have questions regarding billing or which insurance plans we accept, please call us at the phone number below. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Here is a list of insurances accepted by Urology Specialists, PC:

• Medicare
• Medicaid Nebraska
• Nebraska Medicaid Kids Connection
• Medicaid Iowa
• Preferred Plan of Nebr/Iowa
• Exclusive Healthcare
• Mutually Preferred
• Private Health Care Systems (PHCS)
• United Healthcare of the Midlands
• One Health Plan
• Blue Cross/Blue Shield Indemnity
• Blue Cross/Blue Shield HMO
• Blue Cross/Blue Shield PPO (Blue Preferred)
• Blue Cross/Blue Shield POS
• Blue Cross/Blue Shield Wellmark
• PPO USA (for GEHA and GEHA Select)
• Accountable Health Plans (FKA Plaines PPO)
• Coventry Health Care of Nebraska, Inc.
• Ohara
• Mail Handlers
• Midlands Choice HMO
• Midlands Choice PPO
• Choice Care
• Cigna Health Care PPO/EPO
• Aetna HMO
• Aetna PPO

Patient Forms

You can view and/or print the necessary patient forms for your appointment by following these easy instructions. In order to view and/or print the forms, you must have the Adobe Acrobat Reader®, which you probably already have on your computer. If not, you can easily and quickly download a free version of Adobe Acrobat Reader® by going to their website Download Reader.

When viewing the forms in Adobe Acrobat Reader®, the text might appear somewhat fuzzy; this is normal (the forms will print out clearly). To print, just click on the printer icon in the Adobe Reader toolbar above the document.

Once you have the Adobe Acrobat Reader installed, click on these links to view and print the following forms:

• view/print Patient information form
• view/print Prostate health symptom score (BPH)
• view/print Understanding the Cystoscopic Examination
• view/print Ultrasound Information
• view/print Vasectomy Information. We offer vasectomy gift certificates

Hospital Affiliations

Urology Specialists, P.C., maintains affiliations with the following hospitals:

• Memorial Community Hospital
• Alegent Health Immanuel Medical Center
• Jennie Edmundson Hospital
• Alegent Health Mercy Hospital
  800 Mercy Drive
  Council Bluffs, IA 51503
  Telephone: 712.328.5000
  
• Faith Regional Health Services, Norfolk, NE
• Nebraska Methodist Hospital

Urology Specialists, P.C.

Immanuel Plaza West Building 6751 No. 72nd Street Suite 210 Omaha, NE 68122 Tel: 402.572.3737 Toll Free: 877.748.6256 Fax: 402.572.3415 VIEW MAP	Council Bluffs 801 Harmony Street Suite 408 Council Bluffs, IA 51503 Tel: 712.256.6477 Fax: 402.572.3415 VIEW MAP
Norfolk Norfolk Medical Center 301 North 27th Street Norfolk, NE 68701 Tel: 402.572.3737 Toll Free: 877.748.6256 Fax: 402.572.3415 VIEW MAP	Blair Alegent Health Memorial Community Hospital 810 North 22nd Street Blair, NE 68008 Tel: 402.572.3737 Appts only: 402.426.1239 Toll free: 877.748.6256 VIEW MAP