AcuWell LLC

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Patient name

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Available times

Sun, Mar 29

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Mon, Mar 30

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Tue, Mar 31

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Wed, Apr 1

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Thu, Apr 2

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Fri, Apr 3

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Sat, Apr 4

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Insurance verification

Insurance Information

We are in-network with Blue Cross Blue Shield and United Healthcare/Optum. To verify insurance coverage, please submit the required information and we will call you with your coverage details as soon as possible. If you are covered by a different carrier, you may be eligible for reimbursement from your insurance company for our services.

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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*By providing your telephone number to Unified Practice you agree that a representative of Unified Practice and/or contracting clinics can place calls or text messages to the number provided, including appointment reminders and telemarketing, using an automatic telephone dialing system or an artificial or prerecorded voice. Your consent is not a condition of using or purchasing our goods or services.

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