Patient Form Files
If you prefer to download and print forms, the following file is available to expedite your first visit:
Hospital and Surgery Center Affiliations
- Banner Estrella Medical Center
- Banner Del E. Webb Medical Center
- Banner Estrella Sugery Center
- HonorHealth Deer Valley Medical Center
- Surgical Elite of Avondale
- West Valley Hospital
Insurance Carriers
Estrella Ear, Nose and Throat is contracted with a wide variety of insurance plans. Please call if you have a question regarding your personal plan.
AHCCCS Plans
- Arizona Complete Care (Health Net Access) ( Referral Required – No Authorization Required )
- Care First/One Care/Well Care/ Well Care Liberty ( Referral Required – No Authorization Required )
- CMDP ( Referral Required – No Authorization Required )
- Magellan ( Referral Required – No Authorization Required )
- Mercy Care Plan ( Referral Required – No Authorization Required )
- Mercy Care Plan Advantage ( Referral Required – No Authorization Required )
- Mercy Care RHBA ( Referral Required – No Authorization Required )
- United Health Care Community Plan (APIPA) ( Referral Required – No Authorization Required )
- University of Arizona Health Plan-Banner University ( Referral Required – No Authorization Required )
Government Plans
- AARP ( No Referral Required – No Authorization Required )
- AARP Medicare Complete ( Referral Required – No Authorization Required )
- Aetna Medicare Advantage HMO ( Referral Required – Authorization Required )
- Aetna Medicare Advantage PPO ( No Referral Required – No Authorization Required )
- Humana Medicare Advantage ( No Referral Required – No Authorization Required )
- Medicare ( No Referral Required – No Authorization Required )
- Railroad Medicare ( No Referral Required – No Authorization Required )
- Tricare for Life ( No Referral Required – No Authorization Required )
- Tricare HN Federal Services ( Referral Required – Authorization Required )
- Tricare Prime ( Referral Required – Authorization Required )
- Tricare Select ( Referral Required – Authorization Required )
- Tricare VAPC3 ( Referral Required – Authorization Required )
- Triwest VAPC3 ( Referral Required – Authorization Required )
- United Health Care AARP Medicare Complete BHN ( No Referral Required – No Authorization Required )
Major Commercial Plans
- Aetna ( No Referral Required – No Authorization Required )
- Aetna Whole Health ( No Referral Required – No Authorization Required )
- Banner Aetna ( No Referral Required – No Authorization Required )
- BCBS Advantage ( Referral Required – No Authorization Required )
- BCBS of Arizona ( No Referral Required – No Authorization Required )
- Blue Alliance ( No Referral Required – No Authorization Required )
- Cigna CAC ( No Referral Required – No Authorization Required )
- Cigna Great West ( No Referral Required – No Authorization Required )
- Cigna Health Springs (Medicare) ( No Referral Required – No Authorization Required )
- Cigna HMO ( No Referral Required – No Authorization Required )
- Cigna Local Plus ( No Referral Required – No Authorization Required )
- Cigna Open Access ( No Referral Required – No Authorization Required )
- Cigna PPO ( No Referral Required – No Authorization Required )
- Cigna Surefit ( No Referral Required – No Authorization Required )
- HealthNet of Arizona/Ambetter ( No Referral Required – No Authorization Required )
- Humana Choice Care PPO ( No Referral Required – No Authorization Required )
- Humana Choice PPO ( No Referral Required – No Authorization Required )
- Humana Medicare PPO ( No Referral Required – No Authorization Required )
- Humana PPO ( No Referral Required – No Authorization Required )
- United Commerical ACO ( No Referral Required – No Authorization Required )
- United Health Care ( No Referral Required – No Authorization Required )
- United Health Care HMO ( Referral Required – No Authorization Required )
- United Health Care Navigate ( Referral Required – Authorization Required )
- United Health Care PPO ( No Referral Required – No Authorization Required )
Other Commercial Plans
- Allwell Dual Medicare Amber (HMO) SNP ( Referral Required – No Authorization Required )
- Arizona Foundation of Medical Care (AFMC) ( No Referral Required – No Authorization Required )
- Arizona Priority Care (AZPCP) ( No Referral Required – No Authorization Required )
- Beech Street AP Plans ( No Referral Required – No Authorization Required )
- Beech Street Medical Plans ( No Referral Required – No Authorization Required )
- Beech Street PPO ( No Referral Required – No Authorization Required )
- Beech Street Workers Comp (WC) ( No Referral Required – No Authorization Required )
- Corvel Auto Medical PPO ( No Referral Required – No Authorization Required )
- Corvel Auto Medical Workers Comp (WC) ( No Referral Required – No Authorization Required )
- Coventry/First Healht ( No Referral Required – No Authorization Required )
- Gated HMO ( Referral Required – Authorization Required )
- Intel Connected Care ( No Referral Required – No Authorization Required )
- Intergrated Health Plan Auto Medical ( No Referral Required – No Authorization Required )
- Intergrated Health Plan Discount Card ( No Referral Required – No Authorization Required )
- Intergrated Health Plan PPO ( No Referral Required – No Authorization Required )
- Intergrated Health Plan Workers Comp (WC) ( No Referral Required – No Authorization Required )
- Mulitplan ( No Referral Required – No Authorization Required )
- Mutal of Omaha ( No Referral Required – No Authorization Required )
- PHCS ( No Referral Required – No Authorization Required )
- Three Rivers PPO ( No Referral Required – No Authorization Required )
- USA Managed Care ( No Referral Required – No Authorization Required )
Out of Network/Plans Not Accepted
- American Indian Health Program
- Anthem MediBlue Plus HMO
- Anthem Medicare Advantage Plan
- Heath Choice
- Magellan-(Dr. Brenner Only Provider In Network)
Self Pay Rates
- New Patient Consultation $250
- Established Patient Consultation $165
- Hearing Test $100
- Scope $100
- Follow Up $65
- Cauterization $50
- Frenulectomy $140
- Foreign Body Removal $150
Payment Plans are available for most self pay patients.
Available Payment Options
Estrella ENT accepts cash, Discover, Visa and Mastercard for co-pays. The office is unable to accept personal checks at this time.
Athena payment portal
Save time by completing our new patient registration form online before your first office visit.
EENT’s Referral Coordinator’s Direct Number and Contact Info
Our Referral Coordinator direct line is: 623-748-8675 Fax: 623-535-8771.
