Please use the following links to print and fill out our insurance coverage and patient health history forms.
PATIENTS WITHOUT INSURANCE
We request that 100% of the first visit be paid at the time of the visit. On other visits, payment may be made at the end of the week if you sign a credit guarantee form. We are happy to accept your Master Card or Visa.
GROUP OR INDIVIDUAL INSURANCE
When possible, we will call to verify benefits on your insurance. However, the benefits quoted to us by your insurance company are not a guarantee of payment. Payment will be due by you at the time of service for any non-covered services, deductibles or co-pays.
“ON THE JOB” INJURY (Worker’s Compensation)
If you are injured on the job, your care should be paid for under your employer’s Worker’s Compensation insurance. You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance. If your employer does not provide us with this information, if a settlement has not been made within 3 months, or if you suspend or terminate care, any fees and services are due immediately.
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.
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.
Please inform us of any secondary insurance you may have. We will assist you if you need help in filing.
MANAGED CARE PLANS
If you are under a managed care plan, coverage of your services will be explained to you on your first visit. Please inform the receptionist of your employer so that we may contact the proper insurance and educate you of your insurance benefits regarding chiropractic care.
You are asked to authorize this chiropractic clinic to furnish information regarding your case to your insurance company and to assign all benefits as a result of the claim. This permits us to follow-up if benefits are other than anticipated. It also permits us to keep abreast of recent developments with local insurance companies, which enables us to continue to provide you with the most up-to-date information available.