|
Vertical Divider
Mail: Nashville Neuroscience Group 2004 Hayes St, Suite 650 Nashville, TN 37203 |
Applying for Disability/FMLA Coverage
Are You Eligible? In order for your provider to complete any forms regarding your Disability/FMLA status, you must have received treatment at Nashville Neuroscience Group within the last three months. To be eligible for disability benefits that are supported by Nashville Neuroscience Group, you must first complete at least three office visits with your current provider. What Is Required? For any Disability or FMLA forms to be processed and subsequently completed by your Provider, the following must be submitted to Nashville Neuroscience Group by email, fax, postal mail or in person:
Please complete the Medical Records Form if our office does not have a signed release form within the past 12 months. What Fees Are Charged? Before any disability and/or FMLA forms are completed by your provider, a forms fee of $50 is required for the 1st 5 pages completed. An additional $10 per page is required after 5 pages. This fee DOES NOT include the cost of sending any additional records (if requested). This fee can be paid on the website, by phone, or in person. No checks are accepted for payment. The form fee applies only to basic forms and physician statements. For more detailed, multiple impairment questionnaires, the price is higher based on the number of pages. The price for a detailed narrative report is $500. This report is usually requested by an attorney. We do not bill insurance for completion of any narrative reports, physician statements or questionnaires pertaining to Disability/FMLA. How Long Does It Take? The processing time for disability or FMLA forms is 10 – 15 business days after all necessary forms are received at Nashville Neuroscience Group. Failure to submit any of the requirements listed above will result in a delay in processing time or incompletion of forms. |
