Thank you for choosing Sammy Lerma III, M.D. P.A. as your medical home.
Our office complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or gender.
We value your time and, in an effort to simplify your office experience, we ask that you adhere to the following policies and procedures.
Sammy Lerma III MD PA prohibits handguns, both concealed and open carry, in our facilities. We are dedicated to providing a healthy and safe environment for patients, providers, and employees.
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.
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 ensure 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 of your appointment so as to avoid unnecessary waiting at the time of your appointment and out of pocket expenses. Also, a verification of eligibility and benefits is not a guarantee of payment.
Below is a list of insurance providers THAT ARE OUT OF NETWORK which we DO NOT ACCEPT (NOTE: this list is not guaranteed to include all providers that are out of network):
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
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.
Request that your records be sent to Sammy Lerma III MD PA: Use the "Request for Release of Medical Information to Sammy Lerma III MD PA" form (see above 8-2019 pdf) to request that medical records be sent from another doctor's office to Sammy Lerma III MD PA.
Request that your records be sent from Sammy Lerma III MD PA: Use the "Release of Medical Information" (see above 7-1-2019 pdf) to have records sent from Sammy Lerma III MD PA to another Doctor/Facility or to request a copy for yourself.
Note the fee schedule below:
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