Patient Forms
For your convenience, we have made several patient forms available to be downloaded and printed prior to your visit. By completing these forms in advance, you will help us to serve you in a more efficient manner.
In order to access the forms, you must have Adobe Acrobat Reader installed on your machine. All new gynecological patients must fill out forms 1-5. Or download the following forms packet:
New GYN Patient Forms
All new pregnant/ob patients must fill out forms 1-6. Or download the following form s packet:
New OB Patient Forms
Individual Patient Forms
Patient Registration Form
Protected Health Information Form
Patient Privacy Acknowledgement
Family Genetic History Questionnaire
Notice to Patients With Medicaid Coverage
Medicare Patient Self Pay Fee Schedule
Billing
OB-GYN ASSOCIATES of MARIETTA is a division of ATLANTA WOMEN’S HEALTH GROUP (AWHG). All insurance claims will be billed and monitored by AWHG. In addition, AWHG will send statements to patients showing account balances. If you have questions regarding insurance claims, payments or account balances, please call the phone number on your account statement or the AWHG Central Billing Office at 678-891-6552.
All laboratory procedures are billed separately from your office visit. Please contact LabCorp, Quest or Phytest if you have billing questions as a result of a statement that you may have received from them.
INSURANCE PLANS 2021 *If it’s not on the list, give the patient our Tax ID#58-2422542 to call-ins co. * |
| PARTICIPATING: | NON-PARTICIPATING: |
AETNA ALLIANT PPO (NON-EXCHANGE ONLY) ANTHEM BCBS
CHAMPVA CIGNA COVENTRY FIRST HEALTH HEALTH ONE ALLIANCE HEALTH PLAN SELECT HUMANA KAISER DUAL CHOICE/ PHCS ONLY LIFEWELL MEDICAID / AMERIGROUP, PEACHSTATE, CARESOURCE MEDISHARE MULTIPLAN NOVANET PHCS PIEDMONT MY HEALTH 360 CHOICE PLAN QUIK TRIP STATE HEALTH BENEFITS TRICARE/ STANDARD, SELECT, PRIME UNICARE UNITED HEALTHCARE VA MEDICAL/VA COMM CARE NETWK/ | ALLIANT -HEALTHCARE EXCHANGE BCBS PATHWAY PLANS – ALL- “X” OR EMPLOYER (can see GYN) BCBS HPN (HIGH PERFORMANCE NETWORK) CIGNA LOCAL PLUS
KAISER HMO
TRICARE DIRECT, TRICARE HEALTHCARE ALLIANCE, OR TRI-WEST
VA CHOICE |
Please note that OB-GYN Associates, as an affiliate of Atlanta Women’s Health Group, is not contracted with Medicare or Medicare Advantage plans offered by other insurance carriers. Medicare patients may still be seen by our practice but a waiver must be signed to indicate an acceptance that we will not bill Medicare. All services provided will be billed directly to the patient under our “Medicare Patient Self Pay Fee Schedule”. The Fee Schedule can be found on the Patient Forms page of the website.
