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  • Insurance Benefits Investigation for TMS Therapy

  • TMS therapy is covered by many health insurers, including Medicare. Completing the required information in this form will allow us to give you the most current status of your insurance coverage benefits for TMS therapy.

    Our team will begin immediately upon your completion. 

    (This form is HIPAA compliant and we pride ourselves in managing your health care in a respectful, concise and timely manner. )

  • Please complete this contact information. All insurance companies require we validate our inquiry with specific contact information. 

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  • This section is about your healthcare insurance information. 

  • You have just received a request TMS Benefits Investigation from {pleaseProvide}.  You should prioritize this by either completing the BI immediately or letting the participant know that you have received this. 

    To assist here is the information you will need to share. 

    Our Clinics Name: Blue Mountain Psychiatry

    Provider Number:                                     Tax ID Number:

    Provider Type: 

    Our Address:

    Phone Number:

    Services to Verify:

    Consultation: 90792.

    TMS Therapy:  90867, 90868, 90869.

  • Here's an area for you to record details of {pleaseProvide} Benefits Investigation. 

    Contact: ___________________________Date of Call: ________________

    Call Reference Number: __________________

    Insurance Carve Out: ____________________ Direct Phone: _______________ 

     

    {pleaseProvide}     {yourPhone}

  • Should be Empty: