experts in minimally invasive spine surgery

Personal & Billing Information

Please complete all forms sent to you prior to your appointment BEFORE your visit and be sure to bring them with you to your visit. Failure to have these forms completed before visit may delay your appointment or result in rescheduling.

If you feel comfortable doing so, you may also complete the necessary forms by clicking HERE, allowing you to complete them on-line and send them ahead of your appointment.

NOTE: Our practice will submit claims to your insurance carrier as a courtesy to you, however you may still be responsible for services which are denied, for additional patient responsibility for payment as determined by your insurer. Please carefully review the agreement to treat with our practice and to pay for services rendered, which you will be asked to sign before your first visit.

You, the patient, has ultimate responsibility for understanding your specific insurance plan, including the need for referrals or prior approvals, the coverage for specific treatment and the patient’s expected financial contribution.

We don NOT accept all insurances. We currently do NOT participate with:

  • Medicaid or any Medicaid Managed Care Plans
  • NOVA Healthecare
  • Medicare Plus Choice
  • United Healthcare
  • Community Health

IF YOU ARE COVERED FOR THIS SERVICE UNDER WORKERS COMPENSATION OR NO FAULT

We will need the following  information at the time of visit:

Workers Compensation

  • WCB#
  • Carrier Case #
  • Date and Details of Injury
  • Independent Medical Examiner (IME) Records
  • Insurance Company Name
  • Address of Insurance Company
  • Name of Claim Representative
  • Phone and Fax # of Claim Representative
  • Name and Phone # of Attorney (if you have one)

No Fault

  • Carrier Name, Address and Phone #
  • Claim #
  • Date and Details of Accident
  • Independent Medical Examiner (IME) Records
  • Letter of Guarantee
  • Name, Address and Phone # of Attorney

If you have any questions please call us for more information or to clarify the information in question. Our phone # is 716-634-3500.