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Please use the following links to print and fill
out or insurance coverage and patient health history forms. The forms
are formatted in Adobe Acrobat, in order to view them you will need
Adobe Acrobat Reader installed on your computer.
New Patient Form
New Patient (Pediatric) Form
Update Insurance Form
Acupuncture Form
Massage Therapy Form
Speaker Request Form
PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please notify your auto insurance carrier of your visit to our
office immediately. Notify our insurance department immediately if an
attorney is representing you. Although you are ultimately responsible
for your bill, we will wait for settlement of your claim for up to six
months after your care is completed. Once the claim is settled or if
you suspend or terminate care, any fees for services are due immediately.
MEDICARE
We do accept assignment from Medicare. The check is usually sent directly
to our office in payment of the services that Medicare will cover, which
for Chiropractors is ONLY manual manipulation of the spine. Medicare
pays 80% of the allowable fee once the deductible has been met. You
are required to pay the deductible and the remaining 20% as well as
any non-covered services. Our office completes and files the forms for
Medicare at no charge.
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SECONDARY INSURANCE
Please inform us of any secondary insurance you may have. We will
assist you if you need help in filing.
GROUP OR INDIVIDUAL INSURANCE
We attempt to take out as much of the "insurance hassle" as possible
for you. We'll happily telephone your insurance company to verify
your coverage benefits. Please remember, however, that the benefits
quoted to us by your insurance company are not a guarantee of payment.
We will file your claim and await payment for 90 days. If your company
pays the benefits they quote to us, the only services you will be
responsible for are any non-covered services, deductibles or co-pays.
If you have any questions at all regarding you financial responsibilities
at our office, please do not hesitate to ask. Our insurance clerk
has years of experience and will be happy to assist you.
PATIENTS WITHOUT INSURANCE
An increasing number of patients do not have insurance,
or have plans with limited coverage, such as catastrophic policies.
We realize that no one wants to build up a large bill. Therefore,
we have several plans so those patients may receive complete care
without undue financial difficulty. Of course we are always happy
to accept cash, your personal check, MasterCard, Visa or Discover
cards.
Click here to
fill out or update your insurance form
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