Evergreen Medical Acupuncture

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Reason for visit

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Available times

Sun, Dec 4

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Mon, Dec 5

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Tue, Dec 6

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Wed, Dec 7

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Thu, Dec 8

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Fri, Dec 9

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Sat, Dec 10

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Insurance verification

Insurance Information

We are only in-network with Medicare and VA/Triwest. Only Dr. Jill Zundelevich is in-network with Triwest. All of our providers are in-network with Medicare. We are no longer in-network with Cigna or United. Some Medicare Advantage plans cover Acupuncture. Please check the homepage of our website to add your insurance to our system so we can verify it.

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

Auto Accident? No-Fault / Personal Injury

Date of accident Please bring your authorization form to the office

Case/Claim #

Case Manager's Name

Case Manager's Phone #

Address to submit claims

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