Highpoint Healing and Wellness, Valencie Exceus, AP, DOM

Insurance Verification Form

As acupuncture gains more acceptance, more insurance companies are including acupuncture benefits for their customers. Many health insurance policies cover acupuncture treatments. We have successfully processed claims from the following insurance companies: United Health Care, Aetna, Cigna, Humana, Blue Cross & Blue Shield Federal, State, and California.

We are happy to verify your acupuncture coverage with your insurance company; please complete and submit the online form below:

Highpoint Healing & Wellness Insurance Submittal Form

First Name:

Last Name:

E-mail:

Address:

City:

State:

Zip:

Phone:

Referred By:

Insurance Name:

Insurance Telephone#:

Group Number:

Insured ID#:

Insured DOB:

Year:

Insurance Type:

HMO PPO EPO POS
Auto Insurance Workers' Comp.

Condition or illness you are seeking treatment for:

By submitting this form, I understand that my personal information will be used ONLY for the insurance verification process. It will be accessible to the staff at HighPoint Healing and Wellness and to a third-party biller. I understand that I have the right to request any and all restrictions to the use of disclosure of my health information.