Verification of Benefits

Please provide the information requested below. This will allow us to contact your insurance provider and negotiate the best price possible for YOU on your behalf!

You can get it done in 2 quick steps and you’ll be ready to get the treatment you NEED!

Step 1 of 2

A quote of benefits and/or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at the time of service.

Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” Every effort will be made by this office to have all services and procedures authorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under the plan, your insurer will deny payment for that service.

I understand that my health insurance company may deny or limit payment for the services identified above, for any reason (stated or not). If my health insurance company denies payment, I agree to be personally and fully responsible for payment. I also understand that if my health insurance company does make payment for services, I will be responsible for any co-payment, deductible, or coinsurance that applies.

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