White Center Acupuncture

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Reason for visit

Patient name

Email address

Phone number

Available times

Wed, Jul 24

No availabilities found on this day.

Thu, Jul 25

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Fri, Jul 26

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Sat, Jul 27

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Insurance verification

Insurance Information

We accept Aetna, Cigna, Humana, TriWest, Washington Apple or Coordinated Care, Regence, Premera, Kaiser Permanente PPO. Please check with your insurance company for acupuncture benefits and any plan requirements. We will collect any copays or coinsurance at the time of the appointment. If your plan does not cover acupuncture or is not in our network we will make it a point to let you know as soon as possible and you will be responsible for the outstanding balance.

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

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