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Patient Paperwork, Insurance & Billing

We believe in the value of chiropractic care for you and your family and the ability to achieve complete wellness. We have always maintained an affordable fee structure and accept several forms of insurance. Cash, checks and most credit cards are accepted.

Below are all of the forms needed for your visit and a further breakdown of our insurance & billing policy, acceptance & procedures.

  • Your first appointment will consist of your new patient consultation, a thorough health history, and your first treatment session. Please allow up to 90 minutes for this visit.

    Please print and complete the New Patient Forms before you arrive for your first visit. Alternatively, you may fill out your forms in the office by arriving 15 minutes before your scheduled appointment time.

    DOWNLOAD & PRINT (ENGLISH)

    DOWNLOAD & PRINT (SPANISH)


    Optional Forms:

    Automobile Accident Forms

    School Physical Forms

    Policy Form

    Doctors Lein Form

    Please bring with you:

    • A copy of all recent labs and medical reports within the past year
    • A list of all of the current medications you are currently taking including over-the-counter medications.
    • A list of all herbs, vitamins and nutritional supplements you are currently taking.

    Additional guidelines for your first visit:

    • Wear comfortable loose fitting clothing if possible.
    • Please turn off cell phones prior to entering the office.

    If you have any other questions about your first appointment, please feel free to contact us.

    We look forward to meeting you!

    Note: The forms are furnished in PDF format and require Adobe Acrobat, Acrobat Reader, or compatible application to view and/or print. The Acrobat Reader application is available to download for FREE.

  • There are several forms of insurances that we accept. If your insurance is not on the list below, please call the office and we will verify your coverage.

    We accept most insurance plans including:

    • Blue Cross Blue Shield
    • Aetna
    • Cigna

    Most insurance plans have a deductible at the beginning of each calendar year. For example, if you have a $500 deductible; after your insurance is billed you will be responsible for the initial $500 in claims or doctor’s fees. This is above and beyond your office visit co-pay.

    Call the office manager for more information at (239) 332-2555

  • Personal Injury Protection (PIP) Effective January 1, 2013

    PIP DOWNLOAD A COPY OF THIS INFORMATION

    What You Don’t Know Can Hurt You!

    In early 2012, Florida’s legislature made drastic changes to Florida’s no-fault auto insurance law at the urging of Governor Rick Scott and the auto insurance companies. Most significant were changes to the personal injury protection (PIP) component of your coverage that protects you should you unfortunately be involved in an auto accident and sustain injuries.

    While all Florida drivers will still be required to carry PIP coverage, the changes significantly alter how you will be able to seek and obtain medical care for your injuries following an accident. This information is offered to help our patients better understand and prepare for the future.

    New Time Limits in Seeking Treatment

    Unlike the law that expired December 31, 2012, which provides no time limit to seek treatment following an auto accident where your PIP benefits apply, the new law only allows 14 days to seek treatment following the date of the accident. If you do not see a doctor during that timeframe, you will lose the ability to use your PIP coverage for any necessary treatment.

    This makes it critical to consult with a D.O., M.D., or A.R.N.P., and your chiropractor as soon as possible following an accident. If you are not taken by ambulance to the emergency room, follow up with one of the walk in convenient care clinics.

    Changes in Coverage and Treatment Options

    While you will continue to be required to carry and pay insurance premiums for a full $10,000 of PIP coverage, in certain situations you may only be entitled to up to a $2500 reduced benefit. The new law requires you have a determination of an “emergency medical condition” to access the full $10,000 benefit. Most insurance companies will most likely argue you do have no have a serious medical condition and will only allow the $2500 benefit.

    This will most likely be litigated in the future. There are also restrictions on who is allowed to make this determination, unfairly discriminating against chiropractic physicians. This means we will have to refer you to another physician or health care provider to confirm that determination before we can provide necessary care above the $2500 limit. The new law no longer requires your insurance company to pay for massage or acupuncture treatment.

    What to do if Your Auto Insurance Carrier Stops Payment After $2500?

    If your auto insurance carrier stops payment after $2500 for the $10,000 in benefits for which you pay a premium for, you may continue to obtain treatment with our office under a letter of protection if you are represented by a lawyer and are filing a claim for recovery against the at-fault driver.

    Remember you always have the right to seek legal counsel for the early termination of your PIP benefits. Unfortunately, this new law is going to increase the # of lawsuits filed compared to the old law.

    Impact to Your Insurance Premiums

    While the auto insurance and legislature’s goal of these benefit reductions is to attack fraud and reduce costs; there is no requirement in the new law that insurance companies reduce costs for these newly reduced benefits. This is what the insurance carriers lobbied they would do if new legislation was introduced in 2012.

    Carriers were asked to take a 10% reduction in premiums by their rate filings in October 2012, however, most chose not to comply. You may want to monitor you renewal premiums closely, as we are already hearing from patients that their rates are actually being increased.

    Politics and the New PIP Law

    Governor Rick Scott and the auto insurance companies twisted arms to pass this legislation. Several Florida State Students were at the capitol at the time the legislation was being presented. Many were asked why they were wearing t-shirts that said “Stop the Fraud” they responded they did not know why they were wearing the t-shirts-just that they were being paid to do so.

    In my opinion it is evident that the governor and insurance companies were not interested in stopping fraud, otherwise, the legislation passed would have reflected this. Yes the fraud needed to be addressed; however, it was a very small portion of the total claims being paid out. Their interest was only in deepening their pockets $$$.

    For More Information, Concerns or Complaints

    The Florida office of Insurance Regulation may assist you if you experience a problem or have a complaint. You can submit a complaint online by going to their consumer services website at: https//apps.fldfs.com/eservice. You may voice your concerns to your elected representatives in the Florida Legislature.

    Visit: http://www.flsenate.gov/Senators/ find to determine who represents you in both the House and Senate in Tallahassee and to find their contact information. Florida Governor Rick Scott can be contacted by calling 850.488.7146

  • Medicare Part B (Medical Insurance) covers manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider.

    Medicare coverage for chiropractic covers the adjustments/manipulation (80%) unless you are with an HMO. Secondary insurance covers the balance (20%) for adjustments/manipulation that Medicare does not cover.

    The initial consultation/exam is not covered by Medicare, as a result, there is a $120 fee on the 1st visit.

    Medicare requires x-rays to be taken in order for treatment to be covered. If a chiropractor orders the x-rays medicare will not cover the cost. However, if the medicare patient’s primary care doctor ( M.D. or D.O.) orders the x-rays medicare will cover the cost. Most of the time Dr. Kaster has the primary care doctor of the patient order the films. Dr. Kaster will then request the films and go over them with the patient.

  • By law we are able to offer cash patients a prompt pay at time of service discount to patients who are paying cash the same day as their office visit.

    Chiropractic Visits

    • New Chiropractic patients initial evaluation and treatment $185
    • Established Patient Re-Evaluation $120
    • Follow-up Office Visits (for manipulation / adjustment only) $70
    • Extremity manipulation in addition to spinal manipulation: Additional $20 charge

    Additional Treatments

    • Massage $90/hour
    • Ultrasound Treatments: if necessary are hands on and require an additional $20 charge
    • Orthotics: the cost depends on the patient’s needs and ranges from $350-$450
    • Intersegmental Traction $20
    • Interferential current $20
    • Hydromassage $20
    • Spinal Decompression Package – Lumbar DRX9000 – 20 visits for $3500
    • Spinal Decompression Package – Cervical DRX 9000 – 25 Visits for $3500

    Physical Exams

    Weight Loss & Wellness Program
    • Initial Consult $200, weight loss supplements additional.
    • Follow-up Weekly Consults $50

    *All prices subject to change at any time without notice.

Treating Patients in the Fort Myers, Cape Coral & Surrounding Areas Since 2003
With Musculoskeletal Conditions & Other Conditions Requiring Chiropractic Care