Before Your Prosthetics Visit
Choosing a prosthetist is an important step in your recovery. Evaluating, problem solving, and fine-tuning your prosthetic device will be an ongoing process as your needs and abilities change over time. You should feel confident that your prosthetist is highly skilled and a patient and caring listener. We encourage you to schedule a no-fee, no-obligation consultation as you consider the right prosthetics for you.
Forms and Insurance Requirements
In addition to selecting your prosthetist, you will need to understand your insurance coverage. We appreciate that this can be a complicated process, and we are here to help you. Forms and information you will need for your first visit are listed below.If you have any questions, please call us at 413-785-4047.
Required forms and medical documentation for your ﬁrst visit:
- Consent form If possible, please print, complete, and bring this form to your first visit. Copies are also available in our office.
- Medical release form This is necessary for all forms of insurance. Copies are also available in our office.
- Insurance companies require a physician’s notes for a prosthetic device. Please have your medical records faxed to our office at 413-785-4048 ATTN: Medical Record. Your medical records are also extremely helpful to your prosthetist. Any relevant records from your vascular or orthopedic surgeon, physiatrist, primary care doctor, physical therapist, or other medical providers related to your condition will assist your prosthetist in recommending the most appropriate device and components for you and providing continuity of care.
- In addition to your physician’s notes, a prescription from your doctor is required You do not need a prescription for a consultation appointment. However, once you decide to move forward with a device we will need a doctor’s order to bill insurance.
- Please note: MassHealth Primary Care Clinician Plans (PCC) require a referral from your primary care physician. Please have your doctor’s office submit a referral through the MassHealth provider portal. Our NPI# is 1558376913.
The following forms are for your information. They DO NOT need to be completed or signed.
A note about insurance coverage
While all insurance plans require a prescription and physician notes for a prosthetic device, every plan is different. Additional requirements vary by individual and company. We will work with you to help you understand your plan, assist you with requesting the appropriate documentation, and prepare you for any portion of the cost that will be your responsibility. Please call us at 413-785-4047 for information about what your insurance plan requires.