Westchester Wellness Center

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Reason for visit

Patient name

Email address

Phone number

Available times

Sat, May 21

No availabilities found on this day.

Sun, May 22

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Mon, May 23

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Tue, May 24

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Wed, May 25

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Thu, May 26

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Fri, May 27

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Sat, May 28

No availabilities found on this day.

Insurance verification

Insurance Information

1. You agree that all acupuncture benefits must be verified in advance in order to assume that your insurance company will cover the services rendered by Julie Grados LAc. 2. Be advised that your insurance company may verify coverage and still deny to pay a claim. 3. At the time of services we will collect a co-payment from you and bill your insurance company on your behalf. 4. You acknowledge and agree that any dispute between your insurance company and you regarding the amount of your benefits and/or allowed amounts is strictly between you and your insurance company and that Julie Grados is not responsible for what your insurance company may decide to pay; 5. In the event that your insurance company informs Julie Grados that you are eligible for reimbursement for acupuncture services rendered at our office, you agree that we are not responsible for any action that it takes in good faith on your behalf based on such information; for example, Julie Grados shall have no responsibility whatsoever if the claims submitted are subsequently denied for any reason, including, without limitation: the treatment(s) is / are deemed medical unnecessary; your deductible has not been met; you have exceeded your benefit limit; a subrogation of claims; medical notes requested are not received and / or deemed insufficient; service is required to be performed by a medical doctor to qualify for coverage; and/or any other reason.

If you want to use insurance for your visit please fill out the fields below so that we can verify your coverage

Name of Primary Insurance (Blue Cross, Aetna, Anthem etc.)

Insurance Type (HMO, PPO etc.)

ID # on insurance card The ID number on your insurance card

Group number

Insurance Provider Phone Number Located on back of insurance card

Claim address Located on the back of insurance card

City

ZipCode

State

Covered under someone else's insurance plan? Select "yes" if you are covered under someone else's insurance

Patient relationship to insured

First Name of Insured Party First Name of the primary policy holder

Middle Name of Insured Party Middle Name of the primary policy holder

Last Name of Insured Party Last Name of the primary policy holder

Insured Party Date of Birth Date of birth of the primary policy holder

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