New Patient Forms

When coming to your first appointment, please bring your insurance card, photo identification, prescription (if you have it) and the prescribing physician’s contact information.

PATIENT INTAKE FORM

Specialty Care & Financial Assistance Coordinators

Our Specialty Care Coordinators are knowledgeable, experienced and passionate about going “above and beyond” to ensure that all of our patients get what they need, when they need it.

  • Make certain that all insurance coverage criteria are met and that the required medical documentation is on record, so our patients’ insurance claims process smoothly.

  • Stay in close communication with patients throughout the insurance authorization and fitting process.

  • Act as patient advocates and liaisons to a patients’ entire medical team.

  • Help patients coordinate appointments.

  • Can connect patients with community resources and alternative funding sources.

  • Work with patients on designing custom monthly payment arrangements as needed.

  • Offer patients with extensive or life-long needs opportunities to meet peers who have ‘been there’, including one-on-one peer visitation, participation in our networking groups, such Amputees Together of Florida or involvement in WCBL’s Ability Sports Clinics.

Accepted Insurance

Below is a list of accepted insurance companies. Please contact us if you so not see your insurance provider.

AAA
AARP
Access (AWCA)
Accountable Health Plans
Advantra
Adventist
Aetna
Aetna (Workers’ Comp.)
Agency For Persons With Disabilities
AIG (WC)
Allstate
Ama Insurance Agency
Ambetter
America Total Care
American Care Source (ACS)
American Eldercare
American Medical Healthcare
American Medical Security
American Pioneer
American Republic Insurance Company
American Speciality
AmeriChoice (United Healthcare)
Amerigroup
Ameriplan Health
Amerisure
Amerivantage
Amtrust
Ancillary Care Services
APWU
Assurant Health
Auto Owners
Avalon HealthCare, Inc.
AvMed

Bankers
BCBS
Beech Street Network
Benesight
Berkley Risk
Better Health
Bridgefield/Summitt Claims Management
Broad Spire
Care Options
CareCentirx
CarePlus
Carlisle
CCMSI
Celtic
Champus
Champva
Choice Medical Management
Cigna – NOW ACCEPTING
Clear Health Alliance
CMS Ped-I-Care Title XIX
CMS Ped-I-Care Med 3000
CNA
Colonial Penn
Commercial Risk
Commonwealth Service Center
Community Care Network (CCN)
Community Health Partners
Community Health Plans
ConservCare Inc. PPO
Constitution Life Insurance
Core Source
Corvel
Coventry Network
Cypress Care, Inc.
Department of Labor (Workers’ Comp.)
Department of Labor Dfec
DirectDME
Direct General
DMEnsion
Early Steps Program
Eaze Bracing Corporation
Empire Plan/United Healthcare
Employer Claim Benefits
Equitable
ESIS
Evercare (United Healthcare)
Evolutions Healthcare System
Express Health
FCCI
First Comp
First Health
First Services Administrators
Florida Benefit Admin
Florida Health LC
Florida Healthcare Plus
Focus Healthcare Mgmt. Network
Freedom Health (Medicare only)
Gallagher Bassett
GEHA
Geico
Geisinger Health Systems
Gemgroup
GHI
Golden Rule UHC
Gowrie
Great West Healthcare
Group & Pension Administrators, Inc.
Hartford
Health Choice LLC
Health First Health Plan
Health Management Solutions
Healthease
HealthSmart Network
Helios
Home Health Network
Homelink
Hospice
Humana (All Plans, some JSA)
Humana Workers’ Comp.
Infants & Young Children
Infinity
Itegra PPO
Integral Health Plans Inc.
Integral Quality Care
Integrated Administrators
JFP – Globalcare Claims Depart.
Kaiser
Liberty Mutual
Lifetime Benefit Solutions
Magellan
Mailhandlers
Main Street America Group
Managed Care Strategies (MCS)
Managed Cost
Marriott Claims
MCAS
MCM Maxcare
MED 3000 PEDI-CARE TITLE XXI
Medcomp
Medi-Share
Medicaid (Florida)
Medical Mutual
Medical Services Co. (MSC)
Medicare
Medico
Medico Life Insurance
Meridian Health
Mercury
MetLife
MetraComp (Workers’ Comp.)
Mitchell Direct General
Modern Medical
Molina
Monumental Life Ins. Company
MTI/Med Comp USA PPO
Multiplan
Multiple Sclerosis Foundation
Mutual Of Omaha
My Matrixx PPO (Workers’ Comp.)
NALC
Naphcare
National DME Bracefit Division
Nationwide Insurance
Neighborly Care Network
Network Health
NICA
NorthAmerican Risk
Northwood NPN

One Call/MSC
One Health Plan of FL (Great West)
Orchid Medical
Ortoped Inc.
Oxford

PACE
Palmetto GBA/Champus
Paradigm Management
Pasco County Risk Management
Patton Medical
PCS-Priority Care Solutions
Ped-I-Care University of FL
PHCS
Piedmont Community
Plaines Health Network
PMSI Medical Service & Equip.
Point OPGA
Preferred Care Partners
Preferred Medical Health Plan
Prestige
Prime Health Services PPO
Principal
Priority Health
Progressive Medical
Pyramid Life
Quality Health Plans
Quest
Reserve National Insurance Co.
Riscorp/Zenith (Workers’ Comp.)
Rising Medical Solutions Inc.
Risk Management
Rural Carrier Benefit Plan
Secure Horizons (United Healthcare)
Sedgwick
Sheet Metal Workers’ National Health
Simply Healthcare (All Plans)
SMS National
South Florida Community Care Network
Southcare PPO
Southeast Medical Services
Special Funds
Spina Bifida
St. Paul Travelers
State Farm
State Mutual Insurance
Staywell
Student Resources
Summit
Sunshine
Sunshine State Medicaid
Tech Health
TECO Claims Management
Three Rivers Provider Network
Total Medical Solutions
Travelers
TriCare
Tufts
UMR
United American Insurance Company
United Healthcare (all plans)
Universal Health Care
Univita Health, Inc.
US Dept. Of Labor
USAA
Vista Health Plan
Vytra Healthcare
WellCare
WelMED-(Medicare and Medicaid)
Western and Southern
Windhaven
Wright Medical Services
York Risk Services
Zenith
Zone Care USA
Zurich