Forms, Insurance & Payments
The most important forms you will be required to complete when visiting one of our clinics for the first time are listed below. It is important that you complete all forms to the best of your ability.These forms assist the doctor in providing you with an accurate diagnosis.
- Heath History Questionnaire (10 pages)
- Patient Policies (4 pages)
- HIPAA Notice of Privacy Practice (1 page)
- Patient Missed Appointment Agreement (1 page)
- Personal Checks
- Debit Cards
- Visa and Mastercard
- Insurance (read more…)
Medicare (read more…)
Accident and Personal Injury
- Overseas Travelers’ Accident Insurance
- Student Insurance
INSURANCE INFORMATION (PPO)
Most insurance companies now cover acupuncture, but we do not belong
to any PPO insurance network. We do bill insurance for “Out of Plan” or
“Out of Network” for those insurance companies who do cover acupuncture.
If your PPO insurance company covers acupuncture “In Plan”, then in most
cases they will cover it “Out of Plan”. But, it really depends on your individual
If you wish to know if our services are covered on your insurance policy, please make sure to bring in your insurance card and the front office will check to see what kind of coverage you do have on your policy. The information you must provide to the office staff for checking your coverage is whether or not you belong to a PPO or HMO plan, your Member ID Number, First and Last Name and Date of Birth.
Please bring your insurance card on your first visit if you intend to use your insurance.
INSURANCE INFORMATION (HMO)
The only HMO insurance that we accept is KAISER PERMANENTE. If you are
a Kaiser member, you must have a printed copy of the referral form with you.
DISCOUNT PACKAGES & AFFORDABLE LONG-TERM PAYMENT PLANS
Please ask about our different discount packages. We also provide a long-term
payment plan, which provides the patient a way to not only continue treatment,
but also provides them an affordable plan that will meet their budget.
CORPORATE/COMPANY PACKAGE DEALS AVAILABLE !
If your company Insurance Plan does not cover Acupuncture or other Alternative Healthcare methods, contact your Human Resources Department and ask them to contact us about the possibility of contracting that coverage separately with our office. We do offer discount rates for such packages.
Chinese Medicine Acupuncture
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