Insurance Verification – Evidence-based Integrative Care

We are pleased to provide a complimentary verification of your acupuncture benefits. To ensure an accurate check, please provide your information exactly as it appears on your insurance card. Once submitted, our billing team will contact your carrier and provide you with a detailed summary of your coverage via email or phone within 24–48 business hours.

Birth Phone on

Name (As shown on insurance card)

First

Last

Date of Birth (Year-Month-Day)

Confirm Email

Phone Number

Who is Your Insurance Carrier

Member ID (Include Alpha Prefix)

Is this a Medicare Plan?

Reason for seeking care (Short Description)

Is this related to an Auto Accident or Work Injury

Leave empty if it does not apply

Privacy Consent & Disclosure

I agree and consent

I authorize the verification of my insurance benefits and consent to this electronic submission

Disclaimer: A verification of benefits is an estimate only and not a guarantee of payment. Information provided is based on the data shared by your insurance carrier at the time of inquiry. Because insurance companies can provide conflicting information and human error in interpretation may occur, we cannot guarantee the accuracy of this quote.
Final determination of benefits is made only by your insurance company after a claim has been processed. Patients are ultimately responsible for any portion of the bill not covered by insurance.