Patient Resources

Call the member services number on your insurance card and ask the questions below. Write down the date of the call and the reference number the representative gives you. Bring your answers to your visit so we can give you an accurate estimate of your costs.

The main questions to ask:

• Do I have coverage for chiropractic care? Physical therapy? Massage with a licensed massage therapist?
• What is my deductible, how much has been met, and does it apply to chiropractic care?
• What is my out-of-pocket max and how much has been met?
• What is my copay or coinsurance?
• Do I need a referral or prior authorization?
• What is my visit limit, how many have I used, and is it shared with other provider types?
• Are benefits based on the calendar year or a benefit year? If a benefit year, when does it start?

The full questionnaire also covers same-day exam and adjustment copays, physical therapy codes, and imaging, lab, equipment, and orthotics coverage. Fill it in on your computer or phone, or print it and fill it in by hand.

Use this form to have Hawthorne Chiropractic send your health records to another provider, an insurance company, an attorney, or yourself. Fill in who the records are going to, check the records you want released and the reason, then sign and date the form.

To return the signed form:

• Bring it to the front desk at 1222 SE Division St.
• Or fax it to 503-233-4732

The form is valid for 180 days from the date you sign it. Fill it in on your computer or phone, then print and sign, or sign it electronically in Adobe Acrobat or Preview.