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Mitchell PHC
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Mitchell PHC
Home
Patient Resources
Services
About Us
Contact Us
More
  • Home
  • Patient Resources
  • Services
  • About Us
  • Contact Us
  • Home
  • Patient Resources
  • Services
  • About Us
  • Contact Us

Insurance & Payment Information

To ensure you get the quality healthcare you deserve, we have established relationships with a variety of health insurance carriers. We accept most insurance plans including Medicare and Medicaid (see list below). We also welcome self-pay patients and all forms of payments such as cash and credit cards. Payment is expected for medical services rendered at the time of your visit. Co-payments and non-covered charges must be paid at each visit as stated by your plan. If any special arrangements are necessary, please ask to discuss them with our office.  


Ambetter

Amerigroup

Aetna

Blue Cross Blue Shield

Cigna

CareSource

Humana

Medicaid

Medicare

Optum

PeachState

Tricare

Trustmark

United Healthcare


*If you do not see your insurance please verify with the office before making an appointment.


Medicaid for Newborns

It is of vital importance that you complete a letter requesting financial assistance for your newborn immediately after delivery. When you receive your Eligibility Statement, you should bring it to the office. Ideally, your case worker should be notified prior to the delivery. If we do not receive your child’s Medicaid number and Eligibility Statement, you become responsible for our bill. 

Patient Forms

Request for Release (pdf)

Download

HIPAA Consent (pdf)

Download

Patient Registration Disclosure and Consents (pdf)

Download

Notice of Privacy Practice (pdf)

Download

Medical History (pdf)

Download

Patient Registration Form (pdf)

Download

Pediatric Health History Questionnaire (pdf)

Download

Parental Pre-Authorization (pdf)

Download
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Mitchell County Pediatrics and Health Center

94 East Oakland Avenue, Camilla, Georgia 31730, United States

Phone: 229.336.9769 Fax:229.336.3867

Designed by: Chasity Walker

Copyright© 2023 Mitchell PHC - All Rights Reserved

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