Patient Information

Thank you for choosing Sammy Lerma III, M.D. P.A. as your medical home. We value your time and, in an effort to simplify your office experience, we ask that you adhere to the following policies and procedures.

  • Appointments - If you need an appointment, please call in advance. We do not offer walk-in appointments, but we will make every effort to see you as soon as possible. Please inform us of any changes to your address, phone numbers, email address, insurance, pharmacy of choice, and emergency contact information when scheduling your appointment. Please bring an updated list of all your current medications to each appointment.
  • Medication Refills - If you are in need of a refill, please schedule an appointment to see a provider 1 month before you run out of medication. For all early refills, please submit a refill request through your pharmacy. Controlled substance medications will never be refilled or prescribed by phone or pharmacy request; they require an appointment monthly for refills and are subject to regular drug testing. Maintenance medications (i.e. blood pressure medications, diabetic supplies, heart medications, etc.) will require an appointment every 3 months for refills. We do not prescribe pain medications on an on-going basis. If you have chronic pain issues, we will determine an appropriate referral to meet your pain management needs.
  • Missed Appointments - We require at least a 24-hour notice of a cancelled appointment - emergency situations not withstanding. We allow up to 3 missed appointments or appointments cancelled without proper notice per calendar year; after that your account will be forwarded to our management staff for review.

What Should You Know Before Your First Visit?

When you call to schedule your first visit with us, please note that in an effort to make your visit with us as simplistic as possible, you will be asked to provide all of your insurance information at the time of scheduling.

You will also be required to arrive 15 minutes before your appointment time to fill out our new patient paperwork (or you can access these forms by clicking the links below and printing them out prior to your visit).

You will need to bring with you a valid photo ID, your insurance card (if you have insurance), and a list of current medications.

All out of pocket expenses (co-pays, deductibles, private pay office charges) are due in full at the time of the visit, prior to being seen.

In-Network Insurances

Please note that insurance companies have many different plans available and that we may not be in network with all of the available plans. Please call your insurance to check that we are in network before scheduling your appointment. In the event that we are unable to verify your insurance benefits at the time of your appointment, please note that you will be responsible for the office visit charges out of pocket in full until the insurance benefits can be verified. It is your responsibility to make sure the insurance information that we have on file is up to date at the time of scheduling so as to avoid unnecessary out of pocket expenses. Also, a verification of eligibility and benefits is not a guarantee of payment.

Below is a list of potential insurance providers (this list may not be conclusive and does not guarantee service coverage):

  • Aetna - Commercial, PPO, HMO, MCR
  • All Savers (administered by UHC)
  • Amerigroup Medicaid - Star Plus Only
  • Bastrop County Indigent
  • Blue Cross Blue Shield - HMO, PPO, POS, Federal - PAR plan, Triwest VA, Blue Choice PPO, Health Select (requires PCP Selection), Blue Essentials HMO, Medicare Advantage PPO, Star Medicaid, CHIP Medicaid, Star Kids
  • Beechstreet Network
  • Century Healthcare
  • Champ VA
  • Cigna
  • Coresource
  • Coventry
  • DARS
  • FirstHealth
  • Focus Healthcare Network
  • Fortis Network
  • Galaxy Network
  • GEHA
  • Golden Rule - Choice Plus, Health Select
  • Great-West
  • Group & Pension
  • Healthsmart
  • Humana - HMO, PPO, Choice Care PPO, Medicare Advantage PPO (NOTE: NO Gold Choice PPO or HMO)
  • Medicare & All Medicare Supplements
  • Medicaid
  • Meritain Health (Aetna)
  • Multiplan
  • Optimed
  • Pan American Life
  • PHCS (Private Healthcare Systems)
  • Principal Life (Excludes The Edge Network)
  • Railroad Medicare
  • Scott & White Healthcare (BSW Employee Plan Tier 2, EPO, HMO, Medicare Advantage, PPO, Star Medicaid, Seniorcare)
  • Sendero - Star & CHIP Medicaid
  • Seton Health Plan - Smart Health/Seton EPN, Dell Children's STAR & CHIP, Seton Insurance Co EPO/PPO
  • Sheet Metal Workers
  • Standard Life
  • State Farm
  • Superior Medicaid & Superior CHIP - Allwell MCR Advantage
  • Texas Star Network (Work Comp); Texas Mutual (if DOI prior to 1/1/2018)
  • Texas True Choice Network
  • TMHP Medicaid - Texas Women's Health)
  • Tricare (Humana-Military) - East, Prime, Tricare for Life
  • UMR
  • United Healthcare - All Savers, UHC Community Plan Dual Complete (Medicaid & Medicare), CHIP, Choice Plus, Nexusaco
  • Political Subdivision Workers' Compensation Alliance - TASB, TML, Texas Association of Counties Risk Management Pool, Texas Council Risk Management Fund, Texas Water Conservation Association Risk Management Fund

Accepted Workers' Comp Insurance

The below link is a list of Workers' Compensation Networks from the Texas Department of Insurance. Please call your workers' compensation adjuster to check that we are in network before calling to schedule your appointment.

http://www.tdi.texas.gov/wc/wcnet/wcnetworks.html

Medical Records

If you are interested in obtaining your medical records for your personal record, you are encouraged to access them free of charge through the patient portal.

If you would like the office to provide the records, please print and fill out the medical records request form (located at the bottom of the page, or you may pick one up at the office). Note the fee schedule below.

Fees

Paper - $1.00 per page up to the first 20 pages $20.00 for 20 pages) and $0.50 for each page thereafter.

Electronic format: $.05 per page ($50.00 maximum)

Combination or hybrid format: Charge based on above guidelines

$15.00 for executing an affidavit (including notarizing)

$8.00 per copy of an imaging study/film

Third party requests will be charged based on the Texas Medical Board allowable fees.

We do not charge fees for records released directly to:

  • Other physicians
  • Support an application for disability or other benefits or assistance under: Aid to Families with Dependent Children, Medicaid, Medicare, SSI, or Federal Old Age & Survivors Insurance
  • Support an application for or appeal relating to veteran's benefits