Patient Forms

North Carolina Orthotics & Prosthetics would like to extend a warm welcome to all new patients.  We’ll look forward to seeing you soon in one of our offices!

As a new patient, we will need you to complete several forms that we will maintain as a part of your NCOPI file. In preparation for your office visit, we encourage you to complete the necessary paperwork when you have a free moment.

The image below is a link to open the New Patient Packet in PDF format.  You may either complete and submit the paperwork electronically, or print the document and return completed forms when checking in for your appointment.

If you choose to complete the paperwork electronically, please read the following carefully.  Most modern browsers (Chrome, Safari, etc.) will automatically open this document in a PDF viewer.  Please note that it will NOT be possible to electronically complete this document and submit via the default PDF viewer in your browser.  As a result, if you plan to electronically submit the New Patient Packet, please follow these instructions:

  1. Click the image below to open the New Patient Packet in your browser’s PDF viewer.
  2. Follow prompts within the viewer to save the PDF document to a file directory on your computer.
  3. Use the newest version of Adobe Acrobat Reader to open the document.
  4. Complete the form by providing requested information in each field.  Please leave signature and associated fields blank.  The receptionist on duty at your office visit will have a printed copy of your forms available for signing at check-in.
  5. When finished, select the Submit button associated with the NCOPI office location where you will receive care.
  6. Follow instructions provided by Adobe Acrobat Reader to deliver the completed document via email attachment.
New Patient Packet - website download
 

Insurance Information

Each patient’s coverage will be different based on a number of important factors, including the nature of your disability and your provider’s specific guidelines. At North Carolina Orthotics & Prosthetics, we help patients navigate these complexities, and help manage your expectations as to what is covered and what isn’t. After all, we want you to have the best possible outcome, both with your device and your coverage.

NCOPI Participates in the Following Insurance Networks and Plans:

  • Aetna
  • Aetna Medicare
  • Blue Cross Blue Shield of North Carolina
  • BCBS Federal
  • Champus
  • Cigna
  • Humana Gold
  • Medicare
  • NC Health Choice
  • Secure Horizons
  • State Health Plan of North Carolina
  • TechHealth Worker’s Compensation
  • Tricare
  • Veteran’s Administration
  • Wellpath
  • Medicaid

If your insurance is not listed above, we can verify any out of network benefits. For any questions, please contact (252) 436-2611 and speak to one of our Insurance Specialists.

Committed to Maximizing Your Coverage

We plan on being your O&P specialist for life. So, we will act as your professional advocate to help you receive the maximum amount of coverage available under your policy or under law. That means we will continuously communicate with – and often appeal to — your insurance provider.

We Recommend Patients Keep the Following Guidelines in Mind

Get a detailed prescription! We will work with your physician to ensure that your prescription is accurate, thereby enabling you to get the best care and coverage possible.

Be patient. Often, obtaining maximum coverage can take weeks, if not months. While we will do everything we can to expedite the process, many insurance providers need time to study each case closely to verify the level of coverage allowed.

YOU are your own best advocate. As mentioned earlier, we will work with you throughout the process to obtain any authorizations needed, however, in our experience, the most persuasive advocate for coverage is YOU, since you are the one whose life is impacted, you are the one paying the premiums and you are the insurance customer.

Call us when you’re thinking about a new insurance policy. Many disabled people get phone calls from insurance companies who claim they can offer more coverage. So please call us so we may help you understand your options, and what would be covered in your specific situation with any insurer.

Payment plans are available. Even with insurance coverage, the out-of-pocket for an orthotic or prosthetic device can be costly. Please contact our Insurance Specialist at (252) 436-2611 to learn more about your options.

Coverage for transportation available. Through your local NC Division of Medical Assistance, you may qualify for Medicaid-sponsored transportation to our offices.

Be honest with yourself and your practitioner. Devices built for active people are generally more expensive and more difficult for insurance companies to cover. If you lead an active life and need a device to continue leading that life, we’ll work with you to justify a device’s coverage to your insurance provider. If, you aren’t already leading an active lifestyle and still want a device more suited for an active individual, your chances of obtaining maximum coverage are less.

Understanding Medicare Coverage

For patients who qualify for Medicare, coverage can vary, depending on your potential activity levels and mobility. Medicare has defined these five levels, or “K Levels,” of activity and mobility to help determine which device and coverage level is right for you: The more you’re capable of, the higher the level of device you will receive coverage for. Your levels will be determined by your physician, which typically includes a consultation with your Prosthetist. Over time, your K-Level can be adjusted according to changes in your mobility.

Functional Level 0: The patient does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance his/her quality of life or mobility.

Functional Level 1: The patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.

Functional Level 2: The patient has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator.

Functional Level 3: The patient has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.

Functional Level 4: The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.

Improving Prosthetic Coverage for Everyone

The Amputee Coalition of America is actively lobbying on your behalf to improve coverage and obtain what is called “Parity” in the coverage of prosthetic and orthotic devices. While several states have been successful in improving coverage by passing ‘Parity’ legislation, North Carolina does not have these improved coverage laws in place.

To learn more about this effort, click here . To learn more about the ACA’s efforts nationwide, visit their website. In addition, we’ll be addressing these political issues from time to time on our blog.