Please bring your insurance card with you at the time of your first appointment. Your insurance carrier requires that all co-pays be made prior to any services being rendered. You are responsible for any co-insurance, deductibles or non-covered services as required by your insurance. You will receive a statement from our office indicating what your insurance has paid. Any remaining balance is due upon receipt of that statement
If your injury occurred while on the job, please contact our Workers Compensation Department at 800.824.9861 or 937.415.916. We have specialists available to help you file the proper forms in order to receive care in a timely fashion.
Returned Checks/Rejected ACH Withdrawals
A $25 charge will be added to your account for any checks returned or ACH withdrawals rejected by your bank for any reason. This charge is in addition to any fees your financial institution may charge you.
Disability or Insurance Forms
There will be a minimum charge of $10 for completing medical forms. The actual charge depends upon number of pages and complexity of information requested. Please allow 7 to10 days for completion. Payment is due when you pick up the forms. If you would like us to mail the forms to you or your insurance company, payment is due prior to mailing.
We will provide you a copy of your medical records upon request. You will need to sign a letter of release at the time of pick-up. Please allow 30 days for us to copy your records. If you wish for your records to be mailed, there may be an associated fee to cover the mailing costs. You may be charged for additional copies of your medical records.
Please note all charges for copies for Medical Records follow the Current fees allowed by the Ohio Revised code sections 3701.74, 3701.741, and 3701.742, any actual cost of related postage incurred by the health care provider or copy service will also be charged at actual cost as allowed by law.