McCown Chiropractic is accepting Medicare patients

Please complete before your first appointment:

_____________________ is my primary insurance ( bring your card)

If MEDICARE is your PRIMARY call 1-800-633-4227 to determine your chiropractic benefit.

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If you ASSIGNED your Medicare benefit to KAISER, call membership services (360-636-2400) to find out the following:

o Yes, I have DIRECT ACCESS /SELF-REFERRAL benefit.

$______ My co-pay?

_______ Number of visits allowed per year?

o No, I do not have a direct access/self referral benefit. To use my Kaiser insurance, I need a referral from my medical doctor.

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If you ASSIGNED your Medicare benefit to an insurer such as Regence, Premera, Sterling, Humana, Secure Horizons, or AARP call the number on your card to determine your benefit.

o Yes o No Are Dr. Nancy and Dr. Kelly McCown providers in your plan?

o Yes o No Are examinations covered?

o Yes o No Are x-rays covered?

o Yes o No $______co-pay?

o Yes o No Deductible $____________

_______number of visits allowed per year?

We offer affordable time of service rates if you have no coverage.

Go to patient intake forms.