Patient Forms

downloadable forms / Currently not available

For all new patients, please download and print the following forms to bring in before your visit.

Insurance

Accepted Insurance Plans

Kingwood Endoscopy is an in-network provider for most insurance plans in the Houston area and throughout the state of Texas. View our plans below to see if we’re in your network. Because this list can change, please verify that your doctor accepts your insurance plan prior to your appointment.

• AETNA

• BLUE CROSS BLUE SHIELD

• CIGNA

• Humana

• MEDICARE

• MEDICARE RAILROAD

• MOLINA

• MULTIPLAN,

• MULTIPLAN MEDICARE ADVANTAGE

• UnitedHealthcare

• PHCS

• SUPERIOR HEALTH

• WELLMED

FAQS

At The Center

When you arrive you will register and complete two information forms. Our nursing staff will escort you from the lobby to the pre-op area. The procedure will be confirmed, your medical history will be reviewed and a pre-sedation/anesthesia assessment will take place. An IV will be started. The procedure will follow. After your procedure you will be taken to the post-anesthesia recovery unit. Your physician will speak with you about your findings. Discharge instructions will be given.

After The Procedure

The effects of your sedation will wear off quickly. You may feel bloated until you pass some gas introduced during your procedure. You will be discharged to home with the responsible adult of your choice where you may resume your usual diet. Do not operate equipment or vehicles and not do make important decisions or drink alcohol until the following day. If you experience any fever, bleeding or pain at home, please call your physician immediately.

Why do I need someone to drive me home?
You will be required to arrange for a responsible person to escort you safely home after your procedure. Even though you will be awake by the time you are discharged, the medication used to sedate you will cause a change in your reflexes and judgment similar to the effects of alcohol.

How soon will I know the results of the test?
Your physician will speak with you in the post-anesthesia recovery unit regarding any findings. All recovered polyps and biopsies are sent to pathology and those results are reported to you by your physician in approximately one week.

Payment/Insurance

Kingwood Endoscopy participates in a variety of health insurance plans and will file your insurance for you. You are responsible for deductibles and co-insurance payments at the time of arrival to Kingwood Endoscopy. Any “non-covered benefit” as determined by your insurance company will also be your responsibility. Kingwood Endoscopy's Patient Representative can provide you with an estimate of your payment responsibilities during your phone call prior to the procedure.

Methods of payment accepted
Cash, Check, MasterCard, Visa and/or Discover.

Please understand what is NOT included in your Facility fee.

As designated by Medicare and insurance contracts, a facility bills separately from doctors' services. The Facility fee therefore does not include any payment due for:

• Physician Professional Service fee

• Anesthesia Professional Service fee

• Pathology fee (if needed)

• Any additional procedures you and your physician decide to perform that have not been previously scheduled.

If you have billing questions or concerns please do not hesitate to contact us at 832.344.4008

Medicare Beneficiaries
Kingwood Endoscopy will bill Medicare directly for fees associated with your care. As a beneficiary of Medicare, you are responsible for deductibles and co-insurance.

Frequent Questions