Patient Information & Forms

Call-in refills must be requested during the working office hours. Refills require 24 hours advance notice, and there are no refills from Friday through Sunday.

Patients who have not been seen by one of our doctors or patients who require medications not covered within the scope of our practice will not receive medication or refills. Discomfort medicine is prescribed on a medically necessary basis and refilled accordingly. We prescribe only a small quantity of any narcotic discomfort medicine.

If you are in severe discomfort, please go to the emergency room. BY law, many discomfort medications cannot be called into your pharmacist, and you must have a written prescription. These precautions are to prevent physical dependence on pain medications.

For participating insurance carriers, all applicable co-payments, deductibles and charges for non-covered services will be collected at the time of service. NASA will then file an insurance claim directly to your insurance company. If you are insured with a plan that we do not have a participating provider agreement with, payment in full will be required at the time of service. We accept Visa, Master Card or American Express as methods of payment.

NASA physicians are participating physicians with Medicare. Patients are responsible for 20% of the approved Medicare fee for covered services.

*Patients will be asked to present their insurance cards along with picture identification when they check in for every visit or service to a NASA facility. A photo will be taken and put into your electronic medical record at the first visit to verify identity.

Please remember that your insurance policy is a contract between YOU and your carrier. Our staff can assist you in pre-certification and authorization for any necessary testing being performed within a NASA facility but ultimately, this is the patient responsibility. Please check with your carrier for their individual guidelines and requirements.

Please note, if payment is not received from either you or your insurance company within 60 days from the date of service, your account will be considered delinquent and subject to referral to an outside collection agency.

If surgery is needed and you have insurance, all non-covered fees must be paid prior to surgery. The amount required will depend on the type of insurance that you have. Therefore, it is necessary to bring your insurance information and checkbook or cash with you when you come for your appointment. Please arrive 15 minutes before your first appointment to provide us with the appropriate information. We will verify your insurance coverage, and obtain pre-certification for you if that is required. We will file your primary insurance claim for you, and assist you in any problems or delays. If your insurance company has not paid within six weeks, we will expect payment from you directly. Additional collection fees will be added to any outstanding balance for letters and phone calls by NASA staff required to collect money owed. We require a Letter of Protection for all liability cases. Please inform us of your insurance claim number.

• Medicare
• Railroad Medicare
• Blue Cross PPO
• Advantage 65
• Traditional PPS(BCBS)
• Network Blue
• Aetna PPO
• Aetna Medicare Advantage PPO
• First Health and CCN (Coventry Care Network)
• Heritage Consultants Inc.
• Global Medical Management (GMMI)
• Multiplan/PHCS
• NPPN (Plan VIsta) National Preferred Network
• Nova Healthcare Administrators Inc.
• Self Insured Plans HRA/HAS
• Seminole Tribe of Florida
• Naples Gold Network
• CCHCC- Contract includes the following groups:
  • Collier County Government
  • Collier County Sheriff’s
  • Collier County Public Schools