Information & Forms

 

FORMS

Required Forms

Patient Information Form
Patient Responsibilities Form
Patient Health History Form

Forms to be completed as requested

Aquatics Form
DASH
Lower Extremity Functional Scale
Back Index
Neck Index

 

INSURANCE

We offer a valuable service to our patients – free of charge – we file your insurance claims for you! This means we bill your insurance company, they pay us directly for their portion of the fee, and we only collect the patient’s portion from you. Although we try, it is not possible for us to know everything about your insurance coverage. It is ultimately the patient’s responsibility to know the limitations of their health plan. We participate in the following insurance plans:

  • Alliance
  • Blue Cross Federal
  • Carefirst Blue Cross Blue Shield
  • Cigna
  • Informed
  • Medicare
  • PIP/Automotive Tricare Standard/ Tricare For Life
  • United healthcare
  • United Healthcare – MDIPA (PCP referral required)
  • United Healthcare – Optimum Choice (PCP referral required)
  • Workers Compensation

If your insurance plan is not listed above, we will gladly verify any out of network benefits for you.

Automobile Claims – PIP (personal injury protection)

We will bill YOUR automotive insurance carrier as long as we are supplied with the necessary information to do so. You will be required to secure payment for your services and we must have a “direct pay” letter on file. Our office will follow the parameters of your health plan. If your insurance carrier requires a referral from your primary care physician, you must bring one with you on your first visit. We will not submit to your health insurance plan until your PIP has been exhausted. Once we receive your PIP exhaustion letter, we will begin to submit your claims to your health insurance plan. At that time, you will be required to pay any and all necessary co-payments and deductibles.

Workers Compensation

In order to streamline the process of obtaining authorization for your workers compensation claim, we require your adjustor to phone us so that we may obtain all necessary information before your physical therapy treatments are scheduled.

Co-Payment Responsibility

As with any medical facility, all co-payments are due at the time of service. Failure to make your co-payment at the time of service may result in your not being seen for that days visit.

If your child is our patient and you wish to send them in without accompanying them, you will need to make arrangements for payment in advance. We have several payment options available for you. You can pay at the time of service, leave your credit card information on file, pay in advance or finance your co-pays/co-insurance through the Care Credit Program.

Care Credit, is available at our offices to assist you in your payment needs. More information about Care Credit can be obtained at: www.carecredit.com.

 

CLINICAL CORNER

The clinical staff at Frederick Sport and Spine Clinic regularly reviews articles, discusses the content and implements the information into our patient treatments. As a service to the local medical community, we are offering a summary of these articles to you. It is our intention to provide only the most pertinent info in these 1⁄2 page summaries. Further info is available at the clinic. Please take a moment to peruse the information below and contact us if you have any questions about the subject matter.

View Research

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