Insurance Verification

Currently we are in netwok with United Health Care and Cigna. Prior to office visit, please do the following: 1. check with your provider to see if your plan covers acupuncture. 2. are there deductible and it has been met? 3. many other insurance have out of network benefit including acupuncture benefit. Does your policy pay out-of-network costs? if so, is there a different deductible or copay associated with out-of-network costs? 4. Does your plan require a referral from a primary care provider ? Please fill out the following insurance verification form and we will verify your coverage as soon as we can. (Medicare does not cover acupuncture . However, secondary policies may cover treatment.)

Patient Name*

Email*

Patient Phone*

Date of Birth*

Insurance Provider*

Policy Number*

Group Number (if applicable)

Provider Phone Number*

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Orlando Chai Family Acupuncture