Forms

Patients with hand problems can choose to fill out the registration form at home and bring it with them for their appointment.

HMO/ PPO Insurance – 

Medicare 

Workers compensation

Self Pay rate for 2024

  • Intake for to be filled before the appointment
  • Flat rate Specialized Upper extremity Eval $295 by a CHT
  • Flat Rate specialized treatment $150 + Custom splints cost charged separately 
  • If a splint is fabricated on the day of treatment then the flat rate pay plus treatment charges will be due for that day
  • if a splint if fabricated on the day of the evaluation then the Evaluation charge plus the splint charges will be due for that day.

Consent to Treatment of a Minor

Kaiser Permanente

When coming for therapy at Hands-On-Care

  • Please Bring your Prescription 
  • Wear short sleeves / tank top for shoulder patient or layered clothes for your appointment

At Hands-On-Care we accept all PPO Insurances and some HMO’s

If an Insurance plan is not listed here please call us to find out at 408-268-8536. We are always adding new health plans to the list of insurances we accept

  • PPO
    • Blue shield
    • Blue Cross
    • Humana
    • Aetna
    • Fortified Provider Network
    • Claris Pointe
    • United Healthcare 
    • Unicare
    • Interplan Health group
    • TRPN (Three rivers provider network)
    • USA MCO
    • Cigna (Please be advised, most Cigna Plans (PPO) now require authorization after 5 visits. The visits are assessed by 3rd party American Specialty Health (ASH). There may be a waiting period from the time of application to approval and not all visits may be approved despite your unlimited therapy plan.) If you have a problem with this please contact your advocacy group or insurance commissioner.
    • Corvell
    • Great West
  • Workers Compensation (Requires Authorization before patient can be seen)
  • Medicare
  • Tricare (Requires Authorization before patient can be seen)
  • Self Pay 
  • HMO (Requires Authorization before patient can be seen)
    • Kaiser with auth 
    • SCCIPA
    • Stanford Health Plan (Affinity)
    • PAMF 
    • Verity  
    • Medicare Advantage (Requires Authorization before patient can be seen)
  • Some out of Network Plans
  • Please call us to find out if your plan is included as we are constantly adding new plans to service our patients

Our HIPAA Policy can be found here: HIPAA