Patient Information

Insurance Information

Please know your insurance plan! Your co-pay, co-insurance, and/or deductible is/are due at time of service. In order for our office to submit your claim to the insurance company, we require that you provide us with the most updated insurance card at all visits. Please be aware that insurance cards change every year. Before making an appointment, check with your insurance company to ensure that your doctor is in network with your plan.

We participate with the following insurance companies:

***NOTE: as of 10/01/2020, our practice is NOT IN-NETWORK WITH COMMERCIAL UNITEDHEALTHCARE/UHC OR ANY OF ITS AFFILIATED PLANS. You are welcome to be seen as a self-pay patient. We apologize for this inconvenience.

• Aetna (most plans, for plans that we do not participate with see below)
• Anthem Blue Cross Blue Shield (most plans, for plans that we do not participate with see below)
• Carefirst Blue Cross Blue Shield PPO AND HMO (Blue Choice)
• Carefirst Blue Cross Blue Shield-Federal Plan
• Cigna
• Coventry Healthcare
• Great West Healthcare
• Guardian/PHCS
• Healthkeepers
• Kaiser Permanente (only if allowed to go out of network-referrals are required)
• Medicare: if you have a secondary insurance, please make sure that you have taken care of the crossover between Medicare and your secondary insurance (Please call Medicare to take care of this).
• Multiplan PPO/PHCS
• NCAS
• NCPPO
• One Health Plan
• One Net PPO/Coventry
• PHCS
• Principal Financial Group
• The Hartford
• Tricare (referral may be required)

We DO NOT PARTICIPATE with the following insurance companies:

• Aetna MEDICAID, Anthem MEDICAID, ANY MEDICAID
• *****United Healthcare ALL PLANS INCLUDING MEDICAID (as of 10/01/2020)
• Aetna Premier
• Humana
• Affordable Care Act Innovation and Aetna QHP plans
• Discount Medical Insurance Plans and International Plans

Forms and Downloads

• Returning Patient Package
• New Patient Package
• Records Release Form
• Hipaa Notice
• Change of Information Form

Contraceptive Devices

• Contraceptive Device Form
• Waiver Device Removal (English)
• Waiver Device Removal (Español)

NOTE: In order to fill in and save or print these forms on your smartphone or tablets, you will need the free Adobe Acrobat Reader app installed. Click here to download it.

Medical Records and Confidentiality

A federal law known as HIPAA protects patient privacy and prohibits us from disclosing or discussing personal information or treatment regarding a patient without the patient’s written authorization. Therefore, we must always speak with the patient regarding the care we provide, billing, medications, etc. unless there is a written authorization on file. This applies to children/adults/spouses/partners – no exceptions.  Verbal authorizations are not acceptable.

Medical Records are property of the medical practice. Virginia State Law requires that requests for a copy of a patient medical record are made in writing. This request must be HIPAA compliant and must identify the patient including date of birth, current address, and signature. The request must also include where the records are to be sent with full name and complete address. Please allow 10 business days for medical records processing. A fee applies to the copying, mailing, and storing of medical records.

If you request medical records, please email your request to ynagarro@hc4w.net

Medical Record Release Form

Prescriptions & Orders

All prescriptions and orders will be given to the patient during your scheduled office visit. The doctor will either e-prescribe it to your pharmacy on file or provide you with a printed one. As stated in our financial policy, there is a $15 fee to replace lost prescriptions and/or orders.

If you need a refill on an existing prescription, please have your pharmacy fax a refill request to 703-525-1967 or send an e-refill request. Allow 48 hours for a refill request to be processed. Please be aware that if you are running out of your prescription you are probably due for your annual exam or due for an important follow up visit. We will fill your prescription until your appointment date.

Prescriptions requests handled after hours or on weekends by the physician on call are subject to a $45 fee.

Emergencies and After Hours

If the situation is severe, please call 911 or go to the nearest emergency room. During office hours, call your office at 703-528-6300 (Falls Church) or 703-437-8080 (Reston).  After-hours and weekend calls will be answered by the physician on call. Please limit these phone calls to urgent matters. Please call your respective office telephone number and the answering service will page the doctor on call. If the on-call physician has not returned your call after 15 minutes, please contact the answering service again.

A telehealth visit will be charged and submitted to your insurance company if the doctor on call evaluates and treats non-urgent matters. This does not apply to urgent obstetrical concerns such as labor, bleeding, or decreased fetal movement. Be aware that prescription refills or appointment matters will not be handled after hours or on weekends. In the event that the physician on call has to process a prescription refill, you will be charged a telehealth visit. 

Please be aware that as a new patient, we cannot give medical advice or refill prescriptions until you become an established patient. For any urgent matters, please call 911 or contact your previous physician.

To Our Patients,

Healthcare for Women would like to thank you for your support and patience during this pandemic. We have always prioritized the safety and health of our patients and staff. Both our offices are fully open for all types of appointments. Please come see us!

Healthcare For Women COVID Information

Because we care about everyone, we must protect those who are unvaccinated or have compromising health conditions. We want to share the changes in our Covid protocols:

-Everyone is still required to wear a mask inside our office.

-Companions and children (partner/parent/caregiver/interpreter):

• • Children: regardless of age, are not allowed in the office unless they are a patient.
  • Obstetrical patients: one companion is allowed at the pregnancy confirmation appointment and ultrasound appointments only.
  • Parent: only one parent is allowed per patient.
  • Disabled patients or patients needing language assistance: only one companion allowed at all times during the patient’s office visit.

– We implemented remote check-in via Otech/UStart: 2-3 days prior to your appointment, a secured link will be texted and emailed to the patient. We ask patients to complete this process at least 24 hours prior to the appointment time to ensure the completion of forms and a fast check-in process.

-Patients and staff are encouraged to stay at home if they feel sick.