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.

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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: 

Download Form

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