PATIENTS
NEW PATIENT INFORMATION
Welcome! We are passionate to help you by diminishing or preventing chronic pain. What you can expect when you visit our clinic for the first time: An orofacial pain specialist will evaluate and review your current symptoms and medical history, examine areas of the face, teeth, jaw, head and neck, and order any diagnostic testing, if necessary. Also, the specialist will provide a self-care program to reduce any strain to the area and encourage healing. A pain relief treatment plan will be developed and if necessary, sent to your insurer for prior authorization and a summary letter will go to your referring doctor.
You may also be asked for information about your:
- General Health
- Previous diagnosis and treatments (including EMG, MRI, CT scans)
- Health insurance
If you have medical records related to your visit with us, please send them in writing (fax or mail) before your visit. This allows our providers to be fully prepared for your visit.
Other items to bring to your appointment:
- Insurance card(s)
- Driver’s license
- List of names, addresses and phone numbers of other current medical providers
QUESTIONS FOR YOUR INSURANCE COMPANY
Prior to your appointment you may want to review our healthcare team. Then, please call your insurance provider to ask some of the following questions. If you have any difficulty contacting your insurance provider, please let us know so we can help.
INSURANCE
Does your insurance policy cover NON-SURGICAL TMJ?
REFERRAL
Is a referral needed from your primary care clinic? Are there restrictions from your primary care facility on x-rays and imaging, physical therapy services or other treatments? Please note the patient is ultimately responsible for securing their referral from their primary care provider.
COVERAGE
Basic coverage. Examples include: Deductibles, life-time maximums, waiting periods, splint coverage (100%, 80/20%, deductibles, etc.)
OUTPATIENT MENTAL HEALTH
Does your insurance cover outpatient mental health?
Be aware that in the event you see more than one of our clinicians on the same date of service, your insurance company has the right to charge you a copay for each of the clinicians seen. If the insurance company assesses more than one copay, we reserve the right to collect all required copays.
If your plan is a self-insured policy, there may be limitations on the benefits with your insurance carrier. The patient is responsible for knowing their insurance coverage. We do not accept the responsibility for knowing benefits within policies.
INSURANCE
- Medica
- Blue Cross/Blue Shield
- Preferred One
- Medicare
- UCare
- UnitedHealthcare
- and others, please call your insurance or feel free to contact our billing department at (651) 332-7476
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June 15, 2022
