At the time of your first visit, you will be asked to fill out a Personal Information and Medical History form. This information is used by our office for appointment, billing and insurance purposes and by your doctor for diagnosis and evaluation purposes. Please come in 15 minutes early to fill out this form.

Give some thought to your medical history prior to your first appointment so that the form can be filled out quickly and completely. All information provided to us is confidential.

Please bring along any X-rays, lab results, scans or forms (insurance, disability, etc.) that pertain to the medical reason for which you are seeing the physician.

When your turn comes, you will be taken to an examination room.
You will be asked about your past medical history and details about the current condition that brings you to the doctor. The doctor will examine you to determine the nature of your ailment and prescribe treatment.

If it is determined that your situation warrants surgery and your insurance company requires a second opinion or precertification prior to admission, please advise the doctor or his assistant.

Young children generally need to be accompanied in the examination room by a parent or other adult. It is not advisable to bring other children into the room unless absolutely necessary.

When your examination is completed, the receptionists will make a future appointment for you if needed, and will accept your payment and issue you a receipt for payment.

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You are responsible for payment of charges for medical services provided by the clinic. Clinic personnel will gladly submit insurance claims to all major insurance carriers on your behalf. Reimbursement from the insurance carrier will be sent to the clinic, and you will be responsible only for deductibles and co-payments not paid by insurance.

PARTICIPATING PHYSICIANS
All doctors associated with Central Nebraska Orthopedic & Sports Medicine have chosen to participate with Medicare, Blue Cross and Blue Shield of Nebraska, Midlands Choice, Mutually Preferred PPO and Medicaid. The clinic will submit all medical bills involving these insurance carriers directly to the insurance company and will be reimbursed for the appropriate portion of the claim. The patient will be billed for any balance that is not covered by insurance.

SURGERY
If medical treatment involves surgery, the patient must furnish insurance policy numbers to the clinic office prior to surgery. All balances are due within 30 days unless special arrangements are made in advance.

WORKMAN'S COMPENSATION
Please inform us when you register if your injury or medical disorder is job related and covered under Workman’s Compensation. Authorization of such coverage from your employer is required. You will be responsible for all costs not covered by Workman’s Compensation.

DISABILITY INSURANCE
Disability insurance forms will be completed by our office staff and sent directly to the insurance carrier. Your portion of the form must be completed before submitting it to our office.

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Charges for some surgical procedures may include a six-week period of care that includes routine post-operative treatment directly related to the surgery. Unexpected complications or unrelated conditions are not included in estimated charges.

PAYMENT OPTIONS