Michigan Otolaryngology Surgery Associates

It is important to arrive at the office prepared for your appointment. This includes providing information about you, your medical history, your referring physician and your health insurance.

Needed Information

Please call our office to obtain a user name and password for the Patient Portal on our website. You can fill out needed forms on line before your visit or you print each document and bring them with you. This includes:

Medical History and Review of Systems form

Patient Financial Responsibility

Notice of Privacy Practices

Acknowledgement of Receipt

Bring the Following Items with You for Every Visit 

1. Your insurance cards, both primary and secondary. The office will scan your cards both front and back to obtain the insurance address and telephone information. 
2. Picture identification – driver’s license or other photo identification.
3. A written list of your current medications, including the dosage of the medication and the frequency you take it (for example – daily, twice a day, once a week).
4. Your co-payment, which can be paid by cash, check or credit card (VISA, MasterCard, Discover and American Express), as well as debit cards for your Health Savings Account. 
5. Any required written or electronic referral from your primary care physician or authorization from your insurance company.
6. Any previous test results, including blood work, CT and MRI results. If your CT or MRI procedure was done at any other facility than the hospital, please bring the disk showing the images of your procedure. 

Payment Is Expected at Time of Service

Be prepared to pay your insurance copay, insurance deductible or any outstanding balance owed to the practice at the time of service. MOSA provides medical insurance billing services as a courtesy to you. You chose your medical insurance, and you must be aware of your patient responsibilities for payment.