Medical Forms

Prior to your first appointment at the Center, a patient information packet will be mailed to you to complete, sign and bring to your appointment. You also can download these forms with Adobe Acrobat.

Insurance and Billing

Please bring your insurance card to each appointment so that the receptionist can make a copy.

Co-payments are expected at the time of service and should be paid to the receptionist prior to seeing the physician. The Center accepts several forms of payment, including MasterCard, Visa, check and cash.

We will gladly submit your charges to your insurance carrier(s). Please keep in mind that you, as the patient, are ultimately responsible for your bill. The billing department will be glad to answer any questions or concerns regarding your insurance and billing.

If you are being seen under a Workers’ Compensation claim, it is important that we have your claim number, date of injury, employer at the time of injury, and all conditions. In addition, we will also need written authorization from your Managed Care Organization (MCO), or your employer, prior to your appointment. If you cannot provide this information by your appointment date, please call our office as soon as possible.

Please notify your primary care physician prior to your appointment with our office if you are covered by an HMO that requires a referral to our office.

Please keep in mind that Medicare and other insurance companies may not pay for durable medical goods (ace wrap, foot supplies, wheelchair cushions, canes, etc.). It’s a good idea to become familiar with the rules of your health plan if you are injured.

Insurance Contract List

At the time of this posting the insurance companies that we are currently contracted with are as follows. We recommend you contact your particular insurance company prior to your appointment to verify that we are participating providers.

Aetna Medicare HMO/Open Access HMO

Aetna Golden Choice (Medicare PFFS)

Aetna Open Medicare (PFFS)

Aetna HMO

Aetna MC, QPOS, USACCESS, EPO, EC

Aetna Medicare Secondary

Aetna NYL Care

Aetna PPO (Open Choice)

Aetna Prudential

Aetna SC (Select Choice)

Aetna Traditional

Aetna US Access

Anthem BCBS Advance Plan

Anthem BCBS Community Choice

Anthem BCBS Community Preferred

Anthem BCBS Traditional

Anthem Blue Preferred

Anthem HMO

Anthem HMP

Anthem Medicare Select

BWC of Ohio

Cigna PPO

Cigna HMO

HealthReach

HealthReach Plus

HealthReach Advantage

Humana

Humana Gold Choice PFFS (Medicare PFFS)

Humana Gold Choice PPO (Medicare PPO)

Medicaid**MUST HAVE CARD EACH APPT*

Medical Mutual Community Preferred

Medical Mutual HMO Health Ohio

Medical Mutual Super Med Plus

Medical Mutual Super Med Select

Medical Mutual Traditional

Medical Mutual Medicare Advantage PFFS

Medicare

Multiplan/PHCS

NYL Care (Aetna)

Pacificare Secure Horizon Direct (Medicare PFFS)

PFFS (Private Fee for Service-Medicare)

PHCS/Multiplan (Private Health Care Systems)

PHCS/Multiplan EPO

PHCS/Multiplan MD

PHCS/Multiplan POS

PHCS/Multiplan PPO

Prudential (Aetna)

Pyramid Life Todays Options (Medicare PFFS only)

Sterling Medicare

TPAC

Tricare for Life (medicare)

United Healthcare

Unicare (Access card thru Anthem)

Universal Healthcare (medicare PFFS only)