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Patient Information

NEW PATIENTS

To help you prepare for your first appointment in our office, you can find all new patient forms here. Please print and complete the appropriate forms to bring with you to your appointment.

You must arrive with the following information:
* The enclosed patient information forms completed in their entirety
* Driver license, or photo identification, along with your insurance card(s)
* ACTUAL films or CD(s) and written reports of any radiology testing

IF YOU DO NOT HAVE YOUR FILMS OR CD, PHOTO ID, COPAY, OR
INSURANCE CARD(S) AT THE TIME OF YOUR
APPOINTMENT, YOU MAY BE ASKED TO RESCHEDULE

neurosurgeon medical office

INSURANCE INFORMATION

Ohio Bureau of Workman’s Compensation

Capital City Neurosurgery is a provider for Ohio BWC. Please note that C9 approval is required for every office visit. Please bring your BWC card and the name and contact information of your Managed Care Organization (MCO).

Tricare

If you are active duty military personnel, Tricare requires a prior authorization to be submitted by your primary care physician for every office visit.

Insurance Plan Not Listed?

You may also check with your insurer to see if the doctor participates in your specific plan. Your insurer may identify Dr. Kiehm as a provider under his name or they may identify him under the company name, Capital City Neurosurgery, or under the NPI number, 1346590445.

Personal Injury Patients

Capital City Neurosurgery does not bill government or commercial insurance for medical bills resulting from personal injury with pending litigation. Please discuss this with your attorney prior to scheduling.

Self-Pay/Cash Patients

Capital City Neurosurgery does accept self-pay patients. Please call the office for more information.

Medicaid Patients

Capital Neurosurgery is not contracted with Ohio Medicaid or any managed Medicaid plans. We also do not accept Medicaid as a secondary insurance.


Insurances

Anthem/BCBS

Medical Mutual of Ohio

Aetna

Cigna

Medicare

COPC Senior Care Advantage

United HealthCare

Medigold

Tricare

capital city neurosurgery

Failure to arrive at your appointment time may result in the re-scheduling of your appointment. It is our intention to be as timely as possible; however, due to the nature of our specialty, there may be a delay at the time of your appointment and/or circumstances in which your appointment needs to be re-scheduled. We appreciate your understanding in advance.

If you have any questions about the forms or your upcoming appointment, please call us to speak with one of our friendly staff members. (614) 442-0700

neurosurgeon medical office
neurosurgeon medical office

Columbus Office
3600 Olentangy River Road
Building 480
Columbus, Ohio 43214


Mansfield Office
408 Glessner Avenue
Mansfield, Ohio 4490