For your information
Insurance benefits cannot be obtained for the requested services until a completed copy of this form is received in our office. Verification for out of network benefits will be provided within 24 hours after receipt and is good for 30 days. This information will be released to your insurance carrier for benefit verification only. Please note that the information provided in this form is not a guarantee of payment for our services. Prior verification and authorizations only verify that the requested service meets the plan’s definition of medical necessity.