Patient Information

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.

  • 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.

No Concealed or Open Carry Handguns Policy

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.

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.

Insurance

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):

Aetna - Seton Health Alliance
Ambetter
Blue Advantage HMO
Community First
Community Health Choice
First Care Health Plans
Humana HMO Gold & PPO Gold
Idealcare
Medicaid - Molina Health Insurance
Scott & White - BSW Preferred HMO

    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

    8-2019 Request for Release of Med Info to Dr. Lerma.pdf
    7-1-2019 Release of Medical Information.pdf

    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:

    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