Patient Insurance Coverage Support (PICS) Program

Patient Insurance Coverage Resources

iFuse Patient Access Program

PICS Portal

SI-BONE's iFuse Patient Access Program has a secure online portal that enables your office to assist patients with insurance authorization requests for minimally invasive SI joint fusion with iFuse.

Login Request Access

Form

Patient Authorization Form

There are PICS programs offered by SI-BONE. Before any assistance can be provided, SI-BONE must receive a signed authorization from the patient (or the patient’s parent/guardian).

PDF - email or fax  Submit Online

Form Thumb Paperwork

Provider Registration for the PICS Portal Link

* Required

Or download the PDF below and fax to: 
408-557-8312

Download Form

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