Patient Forms

Aetna
Anthem Blue Cross of CA
Anthem Blue Cross of CA Prudent Buyer Plan (all metals)
Anthem PERS Platinum PPO
Anthem Blue Cross UC CARE (Tier 2)
Blue Cross PPO
BCBS Blue Edge
Blue Shield of CA
Blue Shield UFCW Medicare PPO
Cigna/Evicore
Covered California - Blue Shield
First Health PPO
HealthNet PPO
Health Partners (Cigna other payer)
John Muir HMO
JMPN Bright Healthcare
JMPN Brand New Day
JMPN Canopy (NO Medicare Advantage)
JMPN Humana
Kaiser PPO
Medicare
Medigap
Meritain Health
Multiplan
Pacific Health Alliance
PHCS
Tricare
TriWest Healthcare Alliance (except Dr. Humphrey)
UHC (except Dr. Humphrey)
UHC Core
UMR PPO

Affinity Medical Group
Anthem Blue Cross Covered CA - metal plans (silver, gold, platinum)
Anthem Blue Cross UC Select PPO/EPO
Anthem Blue Cross University of CA Student Plan
Anthem PERS Gold Select PPO
Blue Cross Pathway PPO/EPO
Brown and Tolland
Community Health Center
Health Net - Medicare HMO and PPO
Hill Physicians
Humana Medicare PPO
Imperial Health Plan
Kaiser HMO
MedPay
Medi-Share Health Ministry
Motor Vehicle Insurance
One-Call
Sutter
UHC Canopy
UHC Medicare Canopy
Wellcare HMO