Insurance Verification

Whole Body Mantra accepts any insurance that covers out-of-network acupuncture services.

Please complete the form below so that we may contact your insurance provider to obtain details of your exact coverage. All information submitted via this website is confidential.

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

 

Please complete the form below

Patient Name *
Patient Name
Full name as it appears on the insurance card.
Policy Holder Name
Policy Holder Name
OPTIONAL: Please provide the name of the primary policy holder, if different from the patient listed above.
Patient Date of Birth *
Patient Date of Birth
Blue Cross Blue Shield, United Health, Aetna, Cigna, etc.
Please include all numbers and letters.
Insurance Company Phone # *
Insurance Company Phone #
This phone number is usually listed on the back of your insurance card.
Please let me know if you have any further comments or questions.