Ponderay Acupuncture

Let us check your insurance

Please allow up to 2 business days for us to confirm your benefits. We can check your coverage as a courtesy but it is ultimately the patient’s responsibility to confirm benefits and acupuncture coverage prior to your appointment. Please note: We do not take Medicare or Medicaid.

First Name

Last Name

Date Of Birth

Gender

Female

Male

Unknown

Phone Number

Email Address

Primary Insurance Company

Member ID / Policy Number

Please include any letters in front of your member ID number

Relationship to Subscriber

The subscriber is the person subscribing to or carrying the insurance plan.

Self

Spouse

Child

Other

Do you have a secondary insurance company?

Yes

Notes: (optional)

By clicking submit you agree that your submitted data is being collected and stored. I authorize Nelson Comerci L.Ac. to submit medical information regarding diagnoses, treatment, consultations, prescriptions, and insurance company, Medicare, or other third party payor or its authorized agents or representatives for the purpose of determining benefits and facilitating payment.

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Whether it’s your first step to a healthier life or your last resort, Chinese medicine gives you the power to make positive changes.