Informed Consent Agreement to Pay for Non-Covered Services Sample Contracts
Trigger Point Injection and/or Osteopathic Manipulation Informed Consent Agreement to Pay for Non-covered Services (This document is NOT for use by Medicare or Tricare Patients!)Informed Consent Agreement to Pay for Non-Covered Services • October 31st, 2021
Many health plans limit how many times a patient can receive treatments that Dr. Hancock frequently recommends, such as trigger point injections (TPIs) or osteopathic “manipulation” (OMM). Some plans pay for TPIs only 4-6 times per year and/or manipulation no more than 20 times in a year. Still other plans do not pay for those procedures at all. Even when OMM is a covered benefit, your Health Plan might count your prior visits to chiropractors and/or physical therapists (PTs) against the number of times you can see Dr. Hancock for those procedures in a given year. I.e., “You get 20 manipulation visits per year on your Health Plan, but since you already used up 16 of those visits with your chiropractor (or PT), that leaves ONLY 4 visits with Dr.