New Patient Information

Thank you for selecting Arizona Mountain Orthopedics! The information below will walk you through our processes and what to expect at your appointment.

New Patient Forms

Once you have made your initial appointment, you can pre-register by clicking on the below link for New Patient Forms below. 

Please download, print, and complete the forms prior to your arrival. When you arrive at White Mountain Orthopedics, simply check in with our receptionist.

In order to view or print these forms you will need Adobe Acrobat Reader installed.

If you are unable to download and print this form, please contact us and we will send you a packet.

Appointment Information

Time and preparation go into your visit! If you are unable to keep your appointment, please give us 48 hours notice

To make or change an appointment call (928) 537-8777. Our office hours are 8:00am to 5:00pm Monday through Thursday, and 8:00am to 12:00pm on Friday, with the exception of major holidays. We close for lunch and these times will vary. 

Please bring all of the following items with you to your appointment:

  1. A copy of any prior authorization or referral, if required by your insurance.
  2. A completed packet that was sent to you when you made your initial appointment. 
  3. Insurance card(s).
  4. Drivers license for the patient or responsible party.
  5. Workers’ Compensation information (if applicable).
    • Employer’s name, address and telephone number
    • Insurance Carrier name, address and telephone number
    • All Injury Information
  6. Any X-rays, MRIs, or other test results related to this injury.

If you printed and filled out your New Patient Registration packet, please arrive 15 minutes early. If you do not have your New Patient Registration packet filled out, please arrive 30 minutes early to complete your packet.

After Hours Urgent Needs

If you have an urgent need outside of our regular office hours, please call (928) 537-8777. An orthopedic doctor is on-call 24 hours a day.

*Please be prepared to pay co-pays, co-insurance, or other costs not covered by your insurance.

Hospital/Surgery Center Affiliations

Arizona Mountain Orthopedics is affiliated with both Summit Healthcare Regional Medical Center in Show Low, Arizona and Sunrise Ambulatory Surgical Center in Lakeside, Arizona. Please call 928-537-8777 to schedule your appointment for the highest standard of orthopedic care!

Directions

Our physical address is: 4830 Hwy 260 Suite 103 Lakeside, AZ 85929

Insurance and Financial Policies

Billing/Insurance Information

It is your responsibility to make sure that we have accurate and up-to-date information for billing and insurance purposes. It is also important to advise us of any changes to your name, address, and telephone numbers.

Paying Your Bill

If unusual circumstances make it impossible for you to pay for services in full or to meet our terms, we invite you to call or come in to discuss the matter with our Billing Office. This will avoid misunderstandings and keep your account in good standing. Except when hardship or prior credit arrangements warrant, accounts over 90-days past due are referred to our collection agency. 

All collection expenses will become your responsibility, if your account goes to Collections, you will be discharged from the practice. If you have any questions, please ask! We will assist you in any way we can. 

We accept VISA and MASTERCARD. Returned checks incur a $25.00 service charge and all accounts extended past 90-days will be charged a $5.00 re-billing fee/per month. We do not assess finance charges.

PPOs, HMOs, Managed Care and other Contracted Plans

We are contracted with a variety of managed care and insurance plans to provide specialist services. Some of these plans require the patient to have a primary care physician. You may be required to obtain a referral or authorization from either your primary care physician or your insurance plan before any services can be provided to you. You are required to pay your co-pays at the time of service.

Medicare-Part B

We are participating physicians with the Medicare program. You are responsible for your yearly deductible and 20 percent of the allowable charges. Please advise us if Medicare is your secondary payor. If you only have Medicare Part A, you do not have coverage for physician charges.

Supplemental Insurance

If you have supplemental coverage we will automatically submit your claims if you have supplied us with the insurance information. If your supplemental plan pays you, we expect you to forward those payments to us.

Non-Contracted Insurance

Payment is expected at the time of service and we will give you all the information you will need to bill your own insurance. All medical expenses are the patient’s responsibility regardless of insurance coverage.

Cash-No Insurance Coverage

Patients who have no insurance coverage are considered “Self Pay”and are expected to pay at the time services are rendered UNLESS other arrangements have been made in advance with the billing office. For large surgery balances, the hospital will assist you in applying for AHCCCS. If you are not eligible for AHCCCS and there are special considerations, you may apply for aFinancial Agreement with our office. We also take VISA and MasterCard.

Workers Compensation

If you have a work-related or industrial injury/illness, you must report this to your employer and complete a “pink” Worker’s Report of Injury for the Industrial Commission of Arizona and advise us of the name and address of the work comp insurance carrier. We are required to obtain authorization from the industrial carrier for any surgical procedures and certain diagnostic tests. Any claim denied as “non-industrial” or “closed” may be billed to your medical insurance carrier or will become your responsibility.

Automobile or Motor Vehicle Accidents, Legal, Lien

Regardless of litigation pending on any case, accident or otherwise, you are responsible for payment of any and all services rendered to you. Payments cannot be contingent on any settlement, judgment, or verdict for which you may be paid as a result of your injuries. We do not accept liens. We expect payment at the time of service. We will not wait for automobile or third party insurance settlements.

IHS, CHS, AHCCCS or AHCCCS Potential

You must produce your ID card at each visit. If you are no longer eligible or we can’t verify your eligibility, you will be responsible for payment of our charges. If you are “AHCCCS Potential” it is imperative that you apply for coverage within 48 hours from the time of medical care. Failure to follow through will result in you being totally responsible for payment.

Prescription Refills

As our physicians are often in surgery or at the hospitals and not available in the office, please allow a minimum of 4 business days for prescription refills whenever possible. No refills or requests for medications will be considered on weekends or holidays.

Top