Insurance Verification

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Please note we are out of network providers, verification is for out of network coverage only

What can we help you with?

Pain

Fatigue

Digestive issues

Immune health

Stress or anxiety

Poor Sleep

Women's health

Fertility

Neurological disorders

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Have you tried acupuncture before?

Never

Once or twice

A few times

Regularly

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In the past year, what else have you tried?

None

Primary Care

Integrative medicine

Nutrition therapy

Naturopathy

Chiropractic

Physical therapy

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What is your full name?

What’s your email address? *

What is your phone number? *

Some health insurance plans cover acupuncture services. Would you like us to check your benefits?

YES

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Let’s collect your insurance details, what is your member ID? *

What is your date of birth?

YYYY

Please choose your insurance provider:

Aetna

Anthem/ Blue Cross Blue Shield

Cigna

United Health Care

Emblemhealth-GHI

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Are you the primary policyholder? If yes, you may skip to the bottom and submit the form

YES

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What is the primary policyholder’s name?

What is the primary policyholder's date of birth?

YYYY

What is your relationship to the primary policyholder?

Spouse

Child

Other:

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Submit

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