Charm City Healing - Acupuncture + Wellness

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Patient name

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Available times

Fri, May 29

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Sat, May 30

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Sun, May 31

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Mon, Jun 1

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Tue, Jun 2

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Wed, Jun 3

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Thu, Jun 4

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Fri, Jun 5

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Sat, Jun 6

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Insurance verification

Insurance Information

Please note that not all of our services are covered by insurance. If you believe that you have insurance benefits for acupuncture, we will help you verify your benefits. Please allow 48 hours for insurance verification before your appointment. We also recommend that you call your insurance company to verify your acupuncture benefits. If we have not been able to verify coverage, you will be asked to pay our time of service fee.

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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