CONCIERGE SLEEP MEDICINE
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Patient Demographics
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Sleep Apnea Quiz
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Epworth Sleepiness Scale
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    Electronic Referral Form

    Month/Date/Year
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Thank you for your business.
The intake department will process your patient and you will be able to see  the status at any time in the Patient Status page. 

    Insurance Verification Form

    Month/Date/Year
    In-Network Benefits
    Out-Network Benefits
    AISP Insurance References
    Gonzalez and Castellanos (TAX ID: 65-0430812 NPI: 1447285606)  ;  DR Gonzalez (NPI: 1134152051)  :  DR Castellanos (NPI: 1326077967)  :  AISP (TAX ID: 52-2413969 NPI: 1093740235)
    Next to the insurance’s name please find who they bill under.  Split studies, authorization approved for both CPT codes 95810 and 95811is Required.  Brenda (305) 824-3244

    Medica (AISP)................................................. Commercial, Individual and Medicare Plans
    Medicare (AISP)................................................................................................ No Medicaid
    Molina Health Plans (AISP)
    Preferred Care Partners (AISP)............................................................................... All Plans
    Simply Health Plans (AISP)………………………….……..….……………….…..……All Plans
    Tricare (AISP)……………………………………………….………………  ……………All Plans
    United Health Care (G&C).HMO & PPO (No UHC Medicare Complete or Secure Horizons)
    WellCare (AISP)....................................................................................................... All Plans
    Other PPO’s.................................................................. Check with AISP prior to scheduling

    Aetna (G&C) ................................................................................ EPO, PPO, POS & HMO
    AvMed (AISP)............................................................................... PPO, EPO, POS & HMO
    BCBS (G&C)....................... PPO, POS & Blue Options (NO HEALTH OPTIONS or HMO)
    CarePlus (AISP).................................................................................................... All Plans
    Cigna (G&C)..................................................................................... PPO, POS (NO HMO)
    HealthSun (AISP)................................................................................................... All Plans
    Humana (AISP)............................................... PPO, POS, EPO, HMO (with Authorization)

    Leon Medical Centers Health Plan (AISP)............................................................. All Plans
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  • Home
    • Español
  • Contact
    • Español
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