Plant Street Acupuncture

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Available times

Fri, Oct 19

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Sat, Oct 20

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Sun, Oct 21

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Mon, Oct 22

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Tue, Oct 23

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Wed, Oct 24

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Thu, Oct 25

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Fri, Oct 26

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Sat, Oct 27

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Insurance verification

Insurance Information

We are happy to file for insurance as a courtesy to you. As stated by your insurance company: “Verification of benefits is no guarantee of payment.” If you have insurance and we file with your carrier for you, you will be responsible for all charges not paid by the insurance company. In addition, the balance due is your responsibility if we have not received payment from your insurance company within 60 days.

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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