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Patient Information and Forms

Patient Information and Forms

Important Information for Dr. Reid's Patients

 Dr. and Mrs. Reid and Mighty Reid

Dr. Herman Reid, Maria Penn-Reid

and Mighty Reid
7839 S. Professional Drive
Ft. Branch, Indiana
Tele:  (812) 753-5950
or 888-753-5950






Insurance Plans and Financial Policy

Your Responsiblity 

You are financially responsible for the services we provide to you.  As a courtesy to our patients, we will file a claim with your insurance plans.  Payment of copayments and payment for services not covered by your insurance plan is expected at the time of service. Any balance remaining after insurance has paid will be due upon receipt of a bill.

Private Insurance Patients

Dr. Reid participates in most major insurance plans.  If you have not met your deductible, you will be asked to pay for the service provided.  The office will still file a claim with your insurance plan so that you may get credit toward your deductible.

Medicaid Patients

Dr. Reid participates in Indiana Medicaid and Illinois Medicaid programs.  You are expected to have a current Medicaid card at the time of your visit.  If you are pregnant and have not received your Medicaid card, you must have proof of application.  You will be required to sign a waiver making yourself financially responsible for services while a final determination is made on your eligibility.  If you are found ineliglble after 45 days, you will be asked to speak with the financial counselor to make payment arrangements.

Medicare Patients

Dr. Reid participates in the Medicare program.  Keep in mind that Medicare pays for a "well" visit once every two years.  if you request a "well" exam before the year time limit is met, you will be asked to sign a waiver making yourself financially responsible.

Patient Forms

The forms linked below are for the use of the patients of Dr. Herman Reid.   If you have questions about any of the forms, please contact Dr. Reid's office.

Co-pays and Deductibles
Authorization for Treatment
Financial Responsibility
HIPPA Notice of Privacy Practices
Patient Easy Pay Consent Form
Patient Registration Form
Release of Personal Health Information
© 2014 St. Mary's Health System   |  3700 Washington Avenue  |  Evansville, IN 47750  |  (812) 485-4000