Insurance and Forms
At Midwest Physical Therapy and Sports Center,
we are pleased to work with most major insurance companies and networks.
- Medicare
- Railroad Medicare
- State of Nebraska Medicaid
- Blue Cross Blue Shield
- Coventry Healthcare
- Midlands Choice
- Mutual of Omaha
- United HealthCare
- Tricare Certified
If you do not see your insurance provider on
this list, please contact us.
Please take a moment to check your outpatient
physical therapy benefits. You will be responsible for any deductibles,
co-pays, coinsurance and any services
considered non-covered by your plan.
On your first appointment remember
to bring the following information.
All forms can be accessed by clicking the link:
- Insurance card(s)
- Doctor's prescription
- Authorization to treat (if
required by your insurance plan)
- Personal Health History (FORM)
- New Patient Information Form (FORM)
If any of the following apply, please complete and bring in the appropiate form with you.
If we are billing Medicare, please complete this form and bring
it in. (FORM)
If you were involved in an auto accident, please
print out this form, fill it out and bring
it with you in addition to the insurance
(or
no insurance)
form.
(FORM)
If this is a worker’s compensation case, please complete this form and bring
it in. (FORM)
If you don’t have insurance, please click
on this form, fill it out and bring to your first appointment.
(FORM)
If applicable bring:
- Auto insurance cards/information
(both parties) and accident reports.
- Attorney information-business
cards are appreciated.
- Liability information - including a contact's
name.
- Workers' Compensation claim number and contact information.
We are happy
to help you process your insurance information. Just let us know
how we can assist. |
