For your convenience, you may download these forms and bring them into the office upon your visit. They are in pdf format:
Patient Health Forms1
Patient Health Forms2
HIPPA Privacy Notice (download not necessary)
We Are In-Network with Most Insurance Plans!
Give us a phone call and CA Clinic can check on your coverage benefits. You may have coverage you might not be aware of and CA Clinic can provide verification for you. Insurance may cover most or all of your treatment (minus co-pays and/or deductibles). If for some reason you are not covered, please inquire about the cost savings PrePaid Program we have implemented to help reduce the burden of treatment expense.
Below is a list of helpful information:
Our policy is to receive payment at the time of service. We prefer to not bill patients monthly. We are happy to review the Clinic’s fee schedule and insurance billing procedure with you if you would like more information.
Fees are due at the time of service unless special arrangements have been made in advance. We request that you pay your total bill at each visit by check or cash. We have a Pre-Paid Program available which can help you save over multiple visits and long term care. Please inquire at front desk for more detailed information.
We request that you advise our office 24 hours in advance of your scheduled visit if you need to cancel your appointment time. At times there is a waiting list and frequently there are daily appointment requests, and your advance cancellation will allow the Doctor to better serve patients as needed. We thank you for your consideration. If you do not cancel 24 hours in advance, we may ask that a $30.00 charge for the unused appointment time be paid before your next appointment is scheduled to see the Doctor.
If you have insurance for chiropractic and acupuncture care, we will photocopy your insurance card, verify your benefits, and advise you of your insurance coverage, deductible, and/or co-pay. We will file your claim with your insurance company following your appointment, however co-pays and deductibles must be paid at the time of service. We accept check, cash or visa, mastercard or discover card.
We cannot guarantee that your insurance company will pay for your treatment at the Clinic, and we will not know this unless your claim is rejected. In this case, we will try for a medical appeal.
If, however, the insurance company continues to deny payment, the Clinic will bill you, and you can work directly with your employer and the insurance company to appeal their decision.
We reserve the right to not bill insurance, or to accept assignment on insurance.
HEALTH INSURANCE BENEFITS AND COVERAGE:
Many of us are unclear as to what our benefits includes. This can lead to frustration at the time of service. Both our clinic staff and you, our patient, have the responsibility to fully understand your insurance benefits information or your cash payment information. Our clinic receptionists are always happy to call your insurance company for you to get the adequate coverage and benefits.
Currently we are in-network provider with the following insurance companies listed in alphabetical order:
AETNA – (MOST)
BEECH STREET – HMO & PPO
BLUE CROSS/BLUE SHIELD – HMO & PPO
CCN MANAGED CARE
COMPREHENSIVE HEALTH GROUP (CHG)
DEFINITY – PPO
FAMILY HEALTH AMERICAN (TEXAS TRUE CHOICE)
FIRST HEALTH – PPO
HEALTHSMART – PPO
MANAGED COST CONSORTIUM (MC2)
NORTH TEXAS HEALTH NETWORK – ALL PLANS
ONE HEALTH PLAN – ALL PLANS
PREFERRED CHIROPRACTIC CARE (PCC)
PRIVATE HEALTH CARE SYSTEMS (PHCS) – ALL PLANS
PRINCIPAL FINANCIAL GROUP
ROCKPORT HEALTHCARE GROUP
TEXAS TRUE CHOICE TRIAD – PPO
UNITED HEALTHCARE – ALL PLANS
If you do not see your plan listed, you may still call us for verification. New plans are being added and may not yet be available on the website.
We currently are OUT-NETWORK to the following insurance companies:
PACIFICARE – HMO