Driftwood Acupuncture & Wellness

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Available times

Mon, Jul 13

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Tue, Jul 14

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Wed, Jul 15

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Thu, Jul 16

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Fri, Jul 17

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Sat, Jul 18

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Insurance verification

Insurance Information

We are in-network providers with Blue Shield & United Healthcare, but are are NOT in-network with any plans Managed by ASH (American specialty health) If you have acupuncture benefits through another carrier, we are happy to provide you with a Superbill (an itemized receipt) for you to submit for reimbursement, OR, if you prefer, we will bill your insurance as an Out-of-Network Provider. You can also use your Health Savings (HSA) or Flex Spending Account (FSA) to pay for Acupuncture. We would be happy to verify the details of your coverage prior to scheduling your first appointment. Simply send us an email indicating: •Insurance Company Name • Your Name • Date of birth • Primary insured’s name and date of birth if different from you • Member ID • Group # • Plan and we will get back to you within 48 business hours. MEDICARE Medicare does NOT cover Acupuncture. However, Medicare patients can be reimbursed if they have a supplemental PPO insurance plan. Before submitting to your PPO, you must first submit to Medicare, receive their denial, and send the denial letter with your claim to your supplemental PPO. We can provide you with a Superbill for your visit, but cannot file any of the paperwork for you. All payments have to be made to us in full at the time of service.

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

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

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