Acupuncture Insurance Verification

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Check your coverage and eligibility

Thank you for choosing Slope Wellness for your healthcare needs. To help us provide you with the best possible care and ensure a smooth billing process, we ask that you complete this secure insurance verification form so that we can confirm your acupuncture benefits.

What You’ll Need:

Your insurance card
Patient information (name, date of birth, contact details)
Insurance policy details (ID number, group number)
Primary policyholder name and date of birth (if you’re not the primary)
Phone number for provider services (found on the back of your insurance card)

Privacy & Security: Your privacy is important to us. This form is HIPAA-compliant and uses advanced encryption to protect your personal and medical information. All data is securely transmitted and accessible only to authorized staff members.

What Happens Next: Once submitted, our secured 3rd party billing team will verify your insurance coverage and we’ll reach out to you with the benefit information. Please note, any acupuncture services rendered prior to verification, must be paid in full. This helps us minimize unexpected costs and ensures you understand any potential out-of-pocket expenses. If we need additional information, we’ll contact you at the phone number or email you provide.

Please note: There is a wait time of 2-3 business days to hear back from us. This is not a guarantee of benefits or reimbursement. We do not submit insurance claims for massage therapy, but FSA cards are accepted and superbills can be provided.

Need Assistance? If you encounter any difficulties completing this form or have questions about your insurance coverage, please contact our office at (718) 415 – 0738 during our regular business hours.

Please complete all required fields and upload clear images of the front and back of your insurance card.

Insurance Verification Form

Patient's First Name (required)

Please leave this field empty.

Patient's Last Name (required)

Patient's Date of Birth (required)

Phone Number (required)

Are you the primary insurance holder? (required)

YesNo

Insurance Information

Current Insurance Provider (required)

Insurance ID Number (required)

Group Number (if applies)

Phone Number for Provider Services (on the back of insurance card)

Photo Of The Front Of Your Insurance Card (required)

Photo Of The Back Of Your Insurance Card (required)

Policy Holder's Address On Insurance

Street Address (required)

City (required)

State (required)

Zip Code (required)

Email (required)

Consent and Agreement

I authorize communication regarding my insurance information via the email address provided.*

I would like Slope Wellness to contact me to schedule an initial acupuncture appointment