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Patient Forms & Information
New Patient Forms
No Surprises Act Disclosure Notice
Right to Receive Good Faith Estimate Notice
Patient Surgery Information
Office Ergonomics Brochure
Back Talk - Back Information
Blood Thinners Form
WHAT INSURANCE PLANS DO YOU ACCEPT?
We are in-network with almost all major carriers, and we accept Medicare and VA coverage. Tricare/Triwest, Coventry Advantra, United Healthcare, Aetna, Cigna, and some small commercial insurances will require prior authorization before treatment can be provided. All patients must have a consult before we can submit for authorization.
HOW DO I GET PRIOR AUTHORIZATION FROM MY INSURANCE?
Insurance typically requires that we submit clinical information about the history of your condition along with a copy of your MRI report and a request to perform a specific procedure. Often, conservative treatment is required before authorization for injections will be approved. Conservative treatment usually includes use of NSAIDS with no improvement along with failed physical therapy, or chiropractic manipulations with no significant improvement in painful symptoms.
ARE THERE ANY UP-FRONT COSTS?
- are a self-pay patient (no insurance)
- have ever had a collection balance with us
- have an insurance deductible that has not been met or have a surgery center co-pay
you will be required to pay those costs up front at the time of service. Typically we will notify you before your appointment of any upfront costs. We accept Visa, Mastercard, any HRA funding cards with the Visa or Mastercard logo, Care Credit, Check, Money Order, and cash.
Office Visit Checklist
Drivers License, Military ID, or State-issued photo ID
Current Insurance Card(s)
Please have the policy holder’s SSN.
With health history and medications list filled out.
Your MRI Disc
NOT the paper report. The doctor will need to see the images.
Deductible and Copay
Deductibles and copays are due at the time of service.
Everything from Office Checklist
Plus the following items…
You will not be allowed to drive yourself home after the procedure.
Make sure you have spoken with our office regarding your insurance approval status.
Consult our Blood Thinners List
SpineMed Specialists is located at 825 N. Hillside Street. It is tucked in between Wesley Medical Center and Ascension Via Christi St. Francis. If you’re traveling to Wichita for a consultation visit, this list of lodging options are convenient to our office.