Accent On Health Wellness Center LLC

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Available times

Wed, Sep 22

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Thu, Sep 23

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Fri, Sep 24

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Sat, Sep 25

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Insurance verification

Insurance Information

Terms & Conditions for Patients If you have insurance, we will do our best to help you receive your maximum benefits. Insurance is a contract between you and your insurance company. We are not a party to this contract. We will file insurance claims with insurance carrier(s) if you provide us with all of the necessary information. Our office will not become involved in disputes between you and your insurance company regarding deductibles, co-payments, covered vs. non-covered charges, secondary insurance, “usual and customary” charges, procedures they consider experimental, etc., other than supply factual information as necessary. You are responsible for ALL services including any services considered “not medically necessary” by your insurance company. Be sure to keep us and all your providers updated. Thank you. Accent On Health Wellness Acupuncture & Functional Medicine.

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

Employment Accident? Workers Compensation

Date of injury Please bring your authorization form to the office

Case/Claim #

Employers Name

Employers Address

Insurance company name

Insurance company phone

Insurance company address

I have read and accept the Terms of Use and Privacy Policy

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