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Patient Information
During the first scheduled New Patient visit, we make sure to obtain important background information such as your pertinent medical history and give you time to get to know your doctor. We accept most insurances but please contact your carrier to ensure Dr. Ali Davis in an in-network provider.
Please arrive 15 minutes early to your scheduled appointment if you are unable to complete the initial paperwork. The following items are strongly recommended to ensure accurate and safe patient care:
- Insurance card(s)
- List of current prescriptions and/or over-the-counter medication, including dose and frequency
- Pertinent medical and surgical history (cancer, diabetes, rheumatology, cardiology, etc)
- Recent labs results, x-rays, or relevant records
New Patient Forms
Consent to Treat Minor Children
Recommendations
Surgery Forms
Insurance and Payment Information
Out of Network Insurance:
- Medica
- Kansas Medicaid (Primary or Secondary)
- United Healthcare Community
- United Health Care Dual Complete in Kansas
- Cigna Health Springs/True Choice
- Wellcare/Allwell in Kansas
- We are currently not accepting new patients with Humana Medicare Replacement plans
- We are currently not accepting new patients with Tricare Prime, Reserve, or Select plans
Dr. Davis does not participate with Health Share Benefit plans such as One Share, Medi-Share, Aliera, etc.
*If Dr. Davis is an in-network provider and does not have a contract with the insurance company, we will not submit paper/electronic claims. Payment is due at the time of service.
If your plan has a deductible that has not been met, we will collect estimated charges based on your insurance plan the day of your visit.
It is the patient's responsibility to know the terms of their insurance plan. Please verify that you have podiatry benefits with your insurance company.
The patient is responsible for copayments or charges that are not covered by the insurance plan. Overpayment at The Foot Clinic will result in a refund after claims have been processed by your insurance.
Specific questions regarding insurance coverage and benefits should be directed to your employer or insurance company. For our billing and processing information, please contact our Billing Department at (913) 364-1314, ext #3.
