As a courtesy, we will be happy to assist you with insurance claim forms so that you will receive maximum benefits. If you have any commercial insurance, auto insurance, or a workmens compensation claim, a computerized AMA form will be automatically completed and filed for you, however, the responsibility for payment is yours. Some insurance companies require their own form and it is your responsibility to provide these for us. Please fill out your portion and sign in the appropriate places before giving the form to our Financial Counselor.
Our office cannot accept responsibility for negotiating claims with insurance companies or other persons. If you have any questions concerning the coverage of your policy we suggest that you speak directly with your insurance company or agent, they are the only ones qualified to explain your benefits.
We don't file Workers Compensation or auto accident claims. The patient is responsible for payment. We do provide an itemized statement for them to file for reimbursement.
Reminder: When you sign your claim form or the release of authorization on the registration form you are authorizing us to release medical information to your insurance company.
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2304 Hurstbourne Village Dr, Suite 500 Louisville, Kentucky 40299
(502) 583-3189 Fax: (502) 581-1463 email@example.com