Registration

Dear Patient:

If your appointment is at the clinic we would ask that you print and complete our Patient Registration packet and bring the completed items to our office for your first appointment.
Your child CANNOT be seen without this information present in our office.

Other items to bring with you to your first appointment at our office:

  • PRESCRIPTION for therapy from the doctor
  • DRIVER’S LICENSE
  • INSURANCE CARD

If you are a home patient, you will need all of the above information MAILED into Kids In Motion as well as a copy of your insurance card (front AND back), driver’s license (front AND back), the doctor’s prescription requesting therapy, and a completed PAYMENT VERFICATION sheet.

ALL this information needs to be in the office PRIOR to your first visit.
We cannot see your child if we are missing any of these documents.

Please understand that we deal with so many insurance companies; it is impossible for us to know what your insurance covers and what it does not cover. It is your responsibility to know what your insurance company covers and what it does not cover. Each employer dictates to the insurance company what it wants covered for its employees. Please take up your concerns about what is not covered, with your employer or your insurance company. We are only following through with the information you give us about your insurance company.

Lastly, if you need a referral for therapy, please take care of this matter BEFORE you come in for your therapy.

ALL CO-INSURANCES, CO-PAYS, AND DEDUCTIBLES ARE EXPECTED TO BE PAID AT THE TIME OF SERVICE. The coinsurance is a percentage of the allowed amount and is the patient’s responsibility. We will estimate this until we get the first payment. If there is an overpayment, it will be credited to your account. We know your co-pay amounts and the latest amount due on your deductible at the start of your service based on what your insurance company has told us. This will show on your copy of the EOB.

If your deductible has not yet been met, you will be expected to pay the reasonable and customary amount dictated by your insurance company; or if not known the front desk will estimate an amount. This may be an estimate until we see the EOB.

Patients seen at home or at an alternate clinic need to submit a credit card number to be billed the day of service and you may use our Payment Verification Sheet (part of our Patient Registration packet to provide this information. If you prefer to pay monthly, this needs to be set up in advance with a credit card or check and you must pay a month ahead – not behind. Please pay the first visit of the month for that month. If you miss a visit it will show as a credit on your account.

Keep in mind that benefits periodically change, so please inform us of these changes when or if they occur. Additionally, it is important to let us know right away if your insurance company changes. Often insurance companies require PRE-APPROVAL or AUTHORIZATION and these take time to obtain; many do not back-date authorizations, so you may be responsible for the bill if KIM is not notified in a timely manner.

Please help us stay informed so that we may work together for a successful treatment experience.

CONTINUE

2636 South Milford Road
Milford
Michigan
48357
United States