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Complete and bring to Your First Visit
Use this link if you have any insurance besides the others noted (ie BCBS, Aetna, Multiplan, PHCS, Humana, UHC) or are a self-pay patient.
For those patients with Medicare, Medicare Advantage, VHA, Tricare, Dept. of Labor or other "federal" insurance.
Please note that most Cigna plans in Illinois require services to be billed to American Specialty Health. The enclosed forms are needed in order to acquire an authorization for therapy.
Download these forms if we are filing claims for workers' compensation on your behalf.
We are obligated to notify you about how we safeguard your privacy. There is no need to print this form or to bring it to your therapy appointment.
CMS requires providers to offer a good faith estimate of the cost of services or items to uninsured patients or those who pay cash.
