Policy Holder’s Name, Date of Birth.
Your relationship to the Policy Holder (Self, Spouse, Child, Parent, etc.).
* We will only bill directly to one insurance company at a time (Except Pacific Blue Cross, GreenShield). If you are covered by your own as well as a family’s plan, we must claim to your own personal plan first and then claim on the alternate plan.
* Each plan has different policies and restrictions. Some require a doctor’s note for acupuncture treatment while others do not allow for direct billing online. We encourage all of our patients to check with their providers before coming in to ensure that they are eligible for acupuncture.
* Please submit your receipts to your insurance provider directly if they don’t accept direct billing. We always issue a receipt after each treatment so that you can submit your claim and get reimbursed.
