Patient Information

New Patient Forms

All new patients will complete “new patient” paperwork prior to their first appointment. This paperwork can be downloaded from our Website or completed in the office by arriving 15-20 minutes early. The “new patient” paperwork includes our office/practice policies, confidentiality, financial policies, and health insurance coverage information.

NewPatientForms

Insurance

NNI’s specialists are contracted with many health insurance companies as “in network” or “preferred” providers. However, many insurance companies require a referral and/or pre-authorization from another health care provider prior to the first visit at Northwest Neurobehavioral Institute. Our office will assist in verifying health insurance benefits and obtaining pre-authorization when necessary. However, the ultimate responsibility for determining health insurance coverage lies with the patient. Co-pays are expected at the time of the appointment. Our office will process health insurance claims, however, the patient maintains responsibility for any account balance. All accounts are expected to be paid in full within 30 days of issuance of an invoice.

When the patient is a minor, and parents are divorced, a copy of the parenting plan will need to be provided to our office. It is the responsibility of the divorced parents to agree to financial arrangements between themselves, as this office will bill the parent that authorizes services. Whomever holds the health insurance policy that covers the child will be required to sign all “new patient” paperwork, including assignment of benefits authorizing the provider to bill the insurance company for services. Due to the nature of our work, we often need to review extensive medical, school, and other records. We ask that you bring photocopies of records for inclusion in the patient file. At your request, and for a fee, we will copy records for you. Payment for record copying is required at the time records are copied.

Patients are requested to provide 24 hours notice when canceling appointments so that appointments can be offered to other patients. When appointments are scheduled for neuropsychological assessment, they are scheduled to last from 2-8 hours. Last minute cancellations or no-shows prevent this time from being provided to another patient. Therefore, last minute cancellations or no-shows might not be rescheduled and the time for the missed appointment may be billed to the patient.