Patient Info2019-01-25T14:31:07+00:00

Patient Information & Resources

On this page, you’ll find information about the Insurance providers we accept as well as forms, documents and other resources. Please explore the information below and contact us should you need clarification or additional details.


Mon – Thu 8:00 – 4:30
Friday 8:00 – 1:30

 (989) 953-4111

2890 Health Parkway
Mt. Pleasant, MI 48858

Financial Information

As a part of our investment in your health care, we accept most types of insurance.
If your insurance company or product is not listed here or if you have specific questions,
please contact our office at (989) 953-4111 for more information.

We strive for excellence at Central Michigan Orthopaedics. Our staff tries to stay abreast of all insurance changes. Due to the complexity in the insurance industry, it is impossible for us to be aware of every plan provision. We encourage you to contact your insurance company before seeing one of our physicians to verify our participation with your particular insurance plan. If we do not participate with your insurance, then out of network benefits may apply.

Co-payment for all services is due at the time service is rendered. We accept Visa, MasterCard, Discover, Care Credit, cash and checks for your convenience. If you’d like to make a payment or have a question about your bill, please contact our office at (989) 953-4111.

It is our agreement to you to provide the best possible care to our patients. We comply with all applicable state and federal rules and regulations, and we treat every patient in the same manner regarding the extension of credit, collection procedures, and payment.

We will collect debts in a fair and consistent manner. Consistent criteria will be used with all patient financial transactions.

You and or your patient representative agree that you will provide Central Michigan
Orthopaedics (CMO) with all necessary, accurate and current insurance and personal patient billing information. This includes any and all information related to insurance as well as patient billing. You also agree that you are responsible to inform and provide CMO with any updates to this information.

  • CMO will bill all third party insurance carriers that are effective for the date of service and care being provided.
  • You or your patient representative will be asked to sign a financial agreement statement to personally assume financial liability for any balances after insurance has paid their portion.
  • You agree that you will pay all office visit co-pays, and/or deductibles at the time of service.
  • You understand and agree that we are unable to waive patient insurance financial
    responsibility due to federal and state anti-kickback statues. Insured patients will be expected to pay all of their deductibles, co-insurance, and co-pays, etc… as required by law.

CMO participates with many types of insurances.

Auto Insurance and Workers Compensation Insurance are two specific types that require specialized documentation, authorization, and billing rules.

It is important that you discuss either of these two insurance situations with us, prior to being seen in our office and incurring charges.

CMO follows all applicable State and Federal rules, regulations and remedies as they pertain to Automobile Insurance and Workers Compensation Insurance in relation to the patient’s financial obligation, if proper disclosure is not made to CMO.

Surgery Scheduling
In the course of your treatment it may become necessary to schedule surgery or additional procedures. When this occurs you should review your insurance and determine any financial obligations; coinsurance, deductible, etc…that you may have.

  • If you do have insurance financial obligations, CMO expects that these are paid in full no later than 5 business days prior to any surgery performed. If these are not paid, non-emergent procedures or surgeries will be rescheduled.
  • Services that require prior authorization must be authorized prior to any surgery and/or procedure being performed.
  • If a patient has a previous outstanding balance and is in need of surgery and/or a procedure, this balance must be paid prior to the surgery/ procedure being scheduled.

If you do not have insurance coverage then you should discuss your financial obligations prior to being seen in our office. It is still your responsibility to provide our office with all of your patient billing information.

  • All office visits must be paid prior to the self-pay/uninsured patient being seen. Our staff can assist with an estimate of our charges.
  • If you do not have insurance coverage, any planned procedure and/or surgery will require full payment no later than 5 business days prior to being performed.* * * *
    We are willing to work with you to establish equitable payment arrangements for services, procedures or surgical charges. Through full disclosure, of your financial situation, or your insurance situation, we are more than happy to work with you on arriving at the best possible course of action. We can work together to provide a solution.

It is our objective and philosophy that all of our patients receive the best possible care and service regardless of their financial situation. In order for our practice to provide top
notch, quality Orthopaedic care, we believe that your complete understanding of our financial policy, as it relates to your financial obligation, is essential.

If at any time you wish to discuss your account and/or financial obligations with us personally, please contact our Billing Specialist during normal business hours, toll free at (844) 282-9505.

Participating Insurance Companies
Blue Cross Blue Shield
Medicare Plus Blue
Blue Care Network
Medicaid McLaren
McLaren Advantage
United Healthcare Commercial
Workers Comp
Consumers Mutual
Priority Health
Insurance NOT accepted
Priority Health Medicaid

If you have billing questions or concerns contact our billing specialist at (844) 282-9505

If you have billing questions or concerns contact our billing specialist at (844) 282-9505

Central Michigan Orthopaedics & Sports Medicine

Patient Forms

The forms below may be printed and filled out prior to your first visit.

New Patient Packet Download
Patient Financial Handbook Download
CMO Referral Form Download
Privacy Policy Download

Things to bring to your first appointment:
• Driver’s license
• Insurance cards
• Complete patient demographic information form and health history questionnaire
• Any previous X-ray studies, MRI studies or CT scans

Central Michigan Orthopaedics & Sports Medicine

Medical Records Request

How do I get access to my medical records?

We at Central Michigan Orthopaedics are committed to maintaining your medical records in a safe and secure manner.

If you are seeking your medical records to refer to another Physician or Heath Care Facility, you can request that provider to send a fax to Central Michigan Orthopaedics at 989-773-6267, stipulating their specific medical record needs and we will send them directly to that provider.

All other requests for records release require the patient to complete the Medical Release form and Patient Authorization for Disclosure of PHI via Alternative Means completely. If not complete, the form may be sent back to you. You can download the forms below.

Cost of Retrieving your Medical Records:

We will bill for a copy of medical records in accordance with Michigan Law. Once your request is received, you will receive an invoice for the cost of the record. Your invoice can be mailed, faxed or emailed. If you have an email address/fax line, please include this information on the form as this will expedite this process. We will email/fax you an invoice. If you do not have email/fax, or would rather be called with this information, again to expedite the process, please let us know on your release form.

Once your Medical Release forms and payment have been received you can expect to receive your records in the mail within seven to 10 days. If you will be picking up your request at the Office, you will be called when they are ready. ((Medical Records can be picked up at the office, faxed, emailed, or mailed (postage will apply).

Patient Authorization Form Download
Patient Authorization Form (Alternative Means) Download

Notice of Privacy Practices

This notice describes how medical information about you may be used and
disclosed and how you can get access to this information. Please review carefully.

Privacy Policy

Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services.

Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law.

Your Rights Under The Privacy Rule

Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.

You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices – We are required to follow the terms of this notice. We reserve the right to change the terms of our notice, at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment. The Notice will also be posted in a conspicuous location within the practice, and if such is maintained by the practice, on it’s web site.

You have the right to authorize other use and disclosure – This means you have the right to authorize any use or disclosure of PHI that is not specified within this notice. For example, we would need your written authorization to use or disclose your PHI for marketing purposes, for most uses or disclosures of psychotherapy notes, or if we intended to sell your PHI. You may revoke an authorization, at any time, in writing, except to the extent that your healthcare provider, or our practice has taken an action in reliance on the use or disclosure indicated in the authorization.

You have the right to request an alternative means of confidential communication – This means you have the right to ask us to contact you about medical matters using an alternative method (i.e., email, telephone), and to a destination (i.e., cell phone number, alternative address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. We will follow all reasonable requests.

You have the right to inspect and copy your PHI – This means you may inspect, and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper or electronic copies as established by professional, state, or federal guidelines.

You have the right to request a restriction of your PHI – This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You will have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out-of-pocket. We are not permitted to deny this specific type of requested restriction.

You may have the right to request an amendment to your protected health information – This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request.

You have the right to request a disclosure accountability – This means that you may request a listing of disclosures that we have made, of your PHI, to entities or persons outside of our office.

You have the right to receive a privacy breach notice – You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.

If you have questions regarding your privacy rights, please feel free to contact our Privacy Manager. Contact information is provided on the following page under Privacy Complaints.

How We May Use or Disclose Protected Health Information

Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.

Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose PHI to other Healthcare Providers who may be involved in your care and treatment.

Special Notices – We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services offered by our office, for fund­raising activities, or with respect to a group health plan, to disclose information to the health plan sponsor. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.

Payment – Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.

Healthcare Operations – We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions and patient safety activities.

Health Information Organization – The practice may elect to use a health information organization, or other such organization to facilitate the electronic exchange of information for the purposes of treatment, payment, or healthcare operations.

To Others Involved in Your Healthcare – Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person, that you identify, your PHI that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.

Other Permitted and Required Uses and Disclosures – We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker’s compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.

Privacy Complaints

You have the right to complain to us, or directly to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying the Privacy Manager at (989) 953-4111.

We will not retaliate against you for filing a complaint.

Effective Date: 11/1/2016
Publication Date: 11/1/2016

Make an Appointment

Contact us to make an appointment today, with one of our caring physicians. We offer flexible scheduling and take many forms of insurance. Make an appointment today, to begin the healing process.