Make a Payment on Your Account
Visit our online payment form to make a payment on your account. Please contact us if you have any questions.
- Patient Registration
- Health Questionnaire
- Medical Records Release
- Notice of Privacy Practices
- Acknowledgement of Receipt of Notice of Privacy Practices
- Bring all necessary information to your first visit to ensure proper authorization and payment by your insurance:
- Insurance card
- Photo ID
- Co-pay - the patient is responsible for any co-pays and prior balance at the time of service.
- Referral if required for your medical insurance
- If your injury is work-related, an authorization from your worker's compensation insurer MUST be on file.
- The patient is responsible for co-pays at time of service. Additional charges that may not be covered include, but are not limited to, purchase or rental of equipment, orthoses (splints) and supplies. Medicare and most private insurance companies do not pay for exercise equipment. Cash, checks and major credit cards accepted.
- Your physician's Surgical Coordinator will contact your insurance company to verify your coverage and to obtain authorization/pre-certification as necessary for your physician's services. Authorization for surgery by your insurance company does not guarantee payment of benefits. Please make sure you have given the office staff complete up to date insurance information when you first arrive for your consultation and continue to update the staff and/or surgical coordinator of any changes to your coverage.
- We strongly recommend that you contact your insurance carrier as well to obtain an understanding of your coverage as it pertains to the entire surgical package. This office is only responsible for obtaining authorization and coverage information for your surgeon. Insurance coverage verification for all hospital charges and anesthesia charges are not the responsibility of our office.
Please contact our business office at (860) 781-6263 or by fax to (860) 652-8412 to receive assistance with any and all payment issues.