The office accepts any insurance that covers out-of-network acupuncture services

Coverage varies from policy to policy; therefore, please complete the form below so that we may contact your insurance provider to obtain the details of your exact coverage. All information submitted via the website is confidential. Policies vary widely and it is important to fully understand the following when researching coverage:

  • Whether you are covered
  • Whether your policy limits the number of visits per year
  • Whether your policy limits the types of ailments it covers
  • What your deductible is and whether it has been met
  • What percentage of the cost your insurance company will cover

Once you have complete this form, we will contact you within 2 business days outlining the details of your coverage. All payment is due at the time of visit until coverage is verified. 


Patient Name *
Patient Name
Please provide the name of the individual seeking to verify insurance coverage
Policy Holder Name
Policy Holder Name
Please provide the name of the primary policy holder if different from that of the patient.
Patient Date of Birth *
Patient Date of Birth
Address *
Address
Blue Cross Blue Sheild, United Health, Cigna, etc.
Please include all numbers and letters
Please include all numbers and letters
Insurance Company Telephone # *
Insurance Company Telephone #
The telephone number will be listed on the back of your insurance card.
Please let me know if you any further comments or questions