Back N' Balance
Please use the following links to print and fill out our 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. If you do not have Adobe Acrobat Reader you can click here to download it FREE.
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We gladly accept most insurance. Individuals in need of our services who lack insurance and who are worried about the high costs charged by many other clinics need not to worry. we have highly affordable rates and flexible payment plans allowing access to high-quality care for you and your family. We also provide discounts to seniors, disabled individuals, low income individuals, military personnel, students and families.
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.
"ON THE JOB" INJURY (
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.
SECONDARY INSURANCE
Please inform us of any secondary insurance you may have. We will assist
you if you need help in filing.
