Please use the following links to fill out our insurance coverage and patient health history forms.
New Patient Intake – Wirth Chiropractic East
New Patient Intake (Spanish) – Wirth Chiropractic East
Personal Injury Auto Accident – Wirth Chiropractic East
Personal Injury Auto Accident (Spanish) – Wirth Chiropractic East
New Patient Intake – Wirth Chiropractic West
New Patient Intake (Spanish) – Wirth Chiropractic West
Personal Injury Auto Accident – Wirth Chiropractic West
Personal Injury Auto Accident (Spanish) – Wirth Chiropractic West
GROUP OR INDIVIDUAL INSURANCE
In order to help you, we attempt to alleviate as much of the “insurance hassle” as possible. We’ll happily call your insurance company to verify your coverage and explain your benefits. We will file your claim and await payment for 90 days. If your company pays the benefits they quote to us, the only services you will be responsible for are any non-covered services, deductibles, or co-pays. If you have any questions regarding your financial responsibilities with regards to the services we’ve provided, please don’t hesitate to ask. Our insurance clerk has years of experience and will be happy to assist you.
PATIENTS WITHOUT INSURANCE
For patients who have little or no insurance coverage, we will work with you to arrange a flexible payment plan. We want to offer you the care you need without unnecessary financial difficulty. We are always happy to accept cash, your personal check, MasterCard, Visa, or Discover cards.
ON THE JOB INJURY (Workers’ Compensation)
If you are injured on the job, your care should be paid for under your employer’s Workers’ Compensation insurance. You need to inform your employer of the accident and obtain the name and address of their Workers’ Compensation insurance carrier.
PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please notify your auto insurance carrier of your visit to our office immediately. It’s also important to let our insurance department know immediately if an attorney is representing you. We work closely with attorneys and will wait for settlement of your claim for up to six months after your care is completed.
We do accept assignment from Medicare. The check is typically sent directly to our office in payment of the services that Medicare will cover, which for Chiropractors is limited to manual manipulation of the spine. Our office completes and files Medicare forms for our patients at no charge.
Please inform us of any secondary insurance you may have. We will gladly assist you if you need help in filing.