Insurance Forms for Coverage Appeal

Purple Amphibian, PLLC, has provided the insurance forms necessary to start an insurance appeals process. Click the appropriate form to start the process and send it to your insurance company.

United Health Care ● Aetna ● Generic Form

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As a reminder:

1) Purple Amphibian, PLLC/Virginia Austin, CRNFA will bill you for no more than allowed by your deductible/coinsurance;  2) Purple Amphibian, PLLC/Virginia Austin, CRNFA will file a claim with your insurance carrier approximately three weeks after your surgery.
3)   A claim from Purple Amphibian, PLLC/Virginia Austin, CRNFA will be sent to your insurance carrier for the amount your insurance carrier deems is your deductible and/or coinsurance.
4) Purple Amphibian, PLLC/Virginia Austin, CRNFA, is not in network with your insurance carrier. It is our goal to aid you in the insurance process if you decide to appeal your insurance coverage.