[vc_row row_id=”client” css=”.vc_custom_1521479757867{padding-top: 3px !important;padding-bottom: 5px !important;}”][vc_column][/vc_column][/vc_row][vc_row turn_off_parallax=”yes” overlay=”yes” css=”.vc_custom_1527772630645{padding-top: 60px !important;padding-bottom: 90px !important;background-image: url(https://columbusspinesurgery.com/wp-content/uploads/2018/05/new-patient-top-img-inside-office2.jpg?id=2203) !important;}” el_class=”services”][vc_column is_slider=”0″ slide_speed=”4500″][vc_column_text el_class=”section_title white wow flipInX”]
[small class=white] Patient Information[/small]
[/vc_column_text][vc_empty_space height=”55px”][/vc_column][/vc_row][vc_row css=”.vc_custom_1521482135768{padding-top: 10px !important;padding-bottom: 0px !important;}”][vc_column][vc_custom_heading text=”NEW PATIENTS” use_theme_fonts=”yes”][vc_row_inner][vc_column_inner width=”1/2″][vc_empty_space height=”10px”][vc_column_text]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[/vc_column_text][vc_column_text css=”.vc_custom_1522866042082{border-top-width: 1px !important;border-right-width: 1px !important;border-bottom-width: 1px !important;border-left-width: 1px !important;padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;border-left-color: #000000 !important;border-left-style: solid !important;border-right-color: #000000 !important;border-right-style: solid !important;border-top-color: #000000 !important;border-top-style: solid !important;border-bottom-color: #000000 !important;border-bottom-style: solid !important;border-radius: 1px !important;}”]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[/vc_column_text][vc_single_image image=”2197″ img_size=”full” add_caption=”yes” style=”vc_box_shadow_border”][vc_separator][vc_custom_heading text=”INSURANCE INFORMATION” font_container=”tag:h2|font_size:24|text_align:left” use_theme_fonts=”yes”][vc_column_text]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.
[/vc_column_text][vc_column_text]Insurances
Anthem/BCBS
Medical Mutual of Ohio
Aetna
Cigna
Medicare
COPC Senior Care Advantage
United HealthCare
Medigold
Tricare[/vc_column_text][/vc_column_inner][vc_column_inner width=”1/2″][vc_empty_space height=”12px”][vc_single_image image=”2195″ img_size=”full” style=”vc_box_shadow_border”][vc_empty_space height=”12px”][vc_column_text]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.[/vc_column_text][vc_btn title=”COMPLETE NEW PATIENT PACKET” style=”flat” color=”turquoise” size=”lg” align=”center” button_block=”true” link=”url:http%3A%2F%2Fcolumbusspinesurgery.com%2Fwp-content%2Fuploads%2F2018%2F05%2FCCN-Full-Packet-Columbus-Mansfield.pdf||target:%20_blank|” css=”.vc_custom_1527772768476{padding-right: 55px !important;}” el_id=”h1″][vc_btn title=”RELEASE OF INFORMATION” style=”flat” color=”turquoise” size=”lg” align=”center” button_block=”true” link=”url:http%3A%2F%2Fcolumbusspinesurgery.com%2Fwp-content%2Fuploads%2F2018%2F05%2FRelease-of-Information.pdf||target:%20_blank|” css=”.vc_custom_1527772836779{padding-right: 55px !important;}”][vc_btn title=”FINANCIAL POLICY” style=”flat” color=”turquoise” size=”lg” align=”center” button_block=”true” link=”url:http%3A%2F%2Fcolumbusspinesurgery.com%2Fwp-content%2Fuploads%2F2018%2F05%2FFinancial-Policy.pdf||target:%20_blank|” css=”.vc_custom_1527772916667{padding-right: 55px !important;}”][vc_btn title=”REFERRAL FORM FOR REFERRING PHYSICIANS” style=”flat” color=”turquoise” size=”lg” align=”center” button_block=”true” link=”url:http%3A%2F%2Fcolumbusspinesurgery.com%2Fwp-content%2Fuploads%2F2018%2F05%2FReferral-Form-for-Referring-Physicians.pdf||target:%20_blank|” css=”.vc_custom_1527773001775{padding-right: 55px !important;}”][vc_column_text]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[/vc_column_text][vc_empty_space height=”12px”][vc_single_image image=”2199″ img_size=”full” style=”vc_box_shadow_border”][vc_empty_space height=”12px”][vc_single_image image=”2201″ img_size=”full” add_caption=”yes” style=”vc_box_shadow_border”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_custom_heading text=”ADDITIONAL REFERENCES” font_container=”tag:h2|text_align:center” use_theme_fonts=”yes”][vc_row_inner][vc_column_inner width=”1/2″][vc_btn title=”NOTICE OF PRIVACY PRACTICES” style=”flat” color=”turquoise” size=”lg” align=”center” button_block=”true” link=”url:http%3A%2F%2Fcolumbusspinesurgery.com%2Fwp-content%2Fuploads%2F2018%2F05%2FNoticeofPrivacyPracticesApril-2013.pdf||target:%20_blank|” css=”.vc_custom_1527773070263{padding-right: 55px !important;}”][/vc_column_inner][vc_column_inner width=”1/2″][vc_btn title=”PATIENT PORTAL” style=”flat” color=”turquoise” size=”lg” align=”center” button_block=”true” link=”url:https%3A%2F%2Fpatientportal.advancedmd.com%2Faccount%2Flogon%3Flk%3D133351||target:%20_blank|” css=”.vc_custom_1522850846952{padding-right: 55px !important;}”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row css=”.vc_custom_1524084129926{border-top-width: 1px !important;border-bottom-width: 1px !important;padding-bottom: 1px !important;background-color: #ededed !important;border-top-color: #000000 !important;border-top-style: solid !important;border-bottom-color: #000000 !important;border-bottom-style: solid !important;border-radius: 1px !important;}”][vc_column width=”1/3″ is_slider=”0″ slide_speed=”4500″ css=”.vc_custom_1524083991548{border-right-width: 1px !important;border-right-color: #000000 !important;border-right-style: solid !important;border-radius: 1px !important;}”][contact_info][highlight]Columbus Office [/highlight] [br] [small class=black]3600 Olentangy River Road [br]Building 480 [br]Columbus, Ohio 43214[/small][br]
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Phone:(614) 442-0700
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Fax:(614) 678-8851
[/vc_column_text][/vc_column][vc_column width=”1/3″ is_slider=”0″ slide_speed=”4500″ css=”.vc_custom_1524084007922{border-left-width: 1px !important;border-left-color: #000000 !important;border-left-style: solid !important;border-radius: 1px !important;}”][contact_info][highlight]Mansfield Office [/highlight] [br] [small class=black]408 Glessner Avenue [br]Mansfield, Ohio 4490[/small]
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