- Pre-certification of insurance benefits
- Verification of coverage
- Estimate of deductible
Because Chicago Pain Management Center is a referral-based practice, we will need a referral by your treating physician or your primary care doctor. We also require corresponding medical records and a prior authorization for types of insurances that require them for our physicians to be reimbursed. If there is any difficulty in this process, please kindly remind the referring physician’s office to send the information we request. We are happy to assist in the process, but it is ultimately the patient’s responsibility. Medical Records should consist of one year of Medical History/Office Visits, any imaging such as MRIS or X-rays, as well as recent therapies.
New Patient Paperwork
Prior to your appointment, please access OUR PATIENT PORTAL and complete your registration; or be prepared to fill all necessary paperwork at the time of your arrival. All demographic information must be completed before seeing a provider. If you are unable to complete OUR PATIENT PORTAL prior to your scheduled appointment, please arrive 30 minutes early in order to do so.
Release of Medical Information
Please contact our office for medical records release form.
NOTE: We charge $20.00 Copy fee (includes pages 1-10) 10-50 pages ($.50 per page) 51 pages and over ($.25 per page)
- Picture ID card
- Insurance card – up-to-date insurance card to every visit.
- Authorization form (if applicable)
- Referral form from your referring physician (if applicable)
- Medical Records
- MRI reports, disc images, and x-rays
- List of ALL current medications you’re taking
Copayments are due at the time of your appointment