Our orthopaedic surgeons use special orthopaedic history forms to assist them in the evaluation, diagnosis and management of your orthopaedic problem. Many patients appreciate having the time prior to their appointment to completely document their symptoms. We have special forms that are unique to your physician’s subspecialty.

We look forward to the opportunity of managing your orthopaedic problem. Please remember to bring the completed forms with you to your appointment. If you have any questions please do not hesitate to call our office.

All physicians use the following forms. Please download and fill these out prior to your visit. Your physician may have additional forms they require for your visit. Please click the name of your doctor for those forms. If your physician is not listed there are no additional forms required.

Patient Registration

 

Please click on a physician tab to download their specific forms

MEDICAL RECORDS RELEASE – If you need us to release a copy of your medical record we will need a written authorization. You may use this form or provide a letter or other written notice giving us your authorization.

Billing and Insurance inquiries for services provided after January 1, 2014

contact

Mercy Health

513-981-6610  or 1-800-301-3988

________________________________________________

Billing and Insurance inquiries for services provided prior to January 1, 2014

Contact

Billing@csmoc.com

347-9999 and press 4

We participate in most major insurance plans. Please see Billing Insurance Tab for a complete list. If you have questions as to our physician or physical therapy participation in your plan please contact us.

Cincinnati SportsMedicine participates in a variety of insurance plans and will be happy to bill your insurance carrier for your services. Managed care co-payments must be paid before seeing your physician and physical therapist. We accept cash, personal checks, Visa, MasterCard, American Express and Discover. We do understand that insurance payments are sometimes delayed. However, even when an insurance claim is filed, you will receive a statement each month if your account has a balance due. Our financial policy is shown below. We welcome calls or inquiries from our patients, their representatives or payers at any time. We are here to help you and assist you!

We try our best to handle your requests for prescription refills quickly. Call your physician’s medical secretary during normal business hours. Please have the prescription and your pharmacy name and phone number available. Please call 513-347-9999 and press the prompt for your physicians medical secretary.

 

Dr. Frank R. Noyes – Donna McCloy 513-794-8471 or dmmccloy@mercy.com

Dr. Mark G. Siegel – Kristi Rogers 513-794-8470 or kkrogers@mercy.com

Dr. Thomas N. Lindenfeld – Christy Campbell 513-346-7289 or cncampbell@mercy.com

Dr. Michelle Andrews- Zoe Ann Binne 513-346-7294 zabinne@mercy.com

Dr. Marc T. Galloway – Lonnya Hornsby 513-346-4518 or lphornsby@mercy.com

Dr. Samer S. Hasan – Deanna Piercefield 513-346-4520 or drpiercefield@mercy.com

Dr. Matthew L. Busam – Toni Harms, RN 513-346-4519 or tjharms@mercy.com

Our physicians have privileges at all of the major hospitals within the Greater Cincinnati area. Please see the links below for information on a specific facility.

Before your surgery can be scheduled, our benefits verification coordinator will contact your insurance company to verify your coverage. This verification is for our business purposes only and does not relieve you of the responsibility of any deductibles, co-payments or other specific provisions of your particular policy. All patients being admitted to the hospital for surgery or other treatment are strongly encouraged to speak to their insurance company as soon as possible to determine their benefits for all services provided including physician services, anesthesia, hospitalization (whether in or out patient services are provided) and radiology services that may be needed during hospitalization or consultation.

Many insurance companies have mandatory second opinion programs for certain procedures. You must check with your insurance carrier to see if a second opinion is required

We are affiliated with the following hospitals and surgical centers:

 

Bethesda North Hospital Bethesda North Ambulatory Surgery Center Good Samaritan Hospital
Bethesda Surgery Center – TriHealth Jewish Hospital Mercy Health Kenwood Surgical Center
St. Elizabeth Medical Center