Patient Forms

 

Private

Workers Compensation

Personal/Auto Injury

Medicare/Medicaid

We will handle all verification and authorizations on your behalf so you can focus on your therapy and well-being.

Private Insurance

  • Aetna
  • BCBS
  • Cigna / American Specialist Health
  • Humana (HMO, PPO)
  • Point Comfort Underwriters
  • TriCare
  • United Health Care / UMR
  • USAA

  • USFHP

Workers Compensation

  • Department of Labor DOL/ACS
  • Texas Workforce Commission (TWC)
  • Gallagher Bassett
  • Sedgewick CMS
  • USAA
  • HEB Risk Management
  • Liberty Mutual

  • All Non Subscribers

Medicare

  • Traditional Medicare Part B
  • AARP Medicare Complete

  • Aetna Medicare

  • Amerivantage (Integranet/Van Lang)

  • BCBS Medicare Advantage (PPO/HMO)
  • Care Improvement Plus
  • Humana Medicare (PPO/PFFS)

  • Molina Medicare

  • United Health Care Dual Complete

  • United Health Care MMP

  • WellCare – Texans Plus (Value/Classic/Choice)

Medicaid

  • Traditional Medicaid

  • Amerigroup (STAR, Star+Plus, CHIP)

  • Community Health Choice (STAR, CHIP)
  • Molina (STAR, Star+Plus, CHIP)

  • Texas Children’s Plan

  • United HealthCare (STAR, Star+Plus, CHIP)

Marketplace Plans

  • Ambetter by Superior Plan

  • BCBS Blue Advantage HMO

  • Community Health Choice

  • Friday Health Plan

  • Molina

If you cannot find the appropriate form for your needs, please contact us and we will email or fax it to you.

As always, if you need assistance in filling out these forms, please reach out to our staff members.

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