Insurance Billing Information

Insurance Billing

We are in network with*:

Pacific Source
Providence
First Choice Health
Regence of Oregon
United Health Care

Benefits must be verified by our office before insurance is accepted in lieu of full payment, and is no guarantee of coverage.

Call (541)241-3135 for a free benefits check, or fill out the form below.

*PLEASE NOTE: We are not in Network with any Medicare Supplemental Plans, and we do not take Medicaid (Pacific Source Community Solutions). These plans carry a heavy administrative burden and cost that we cannot justify with our small clinic. We apologize for the inconvenience.

MVA (Motor Vehicle Accident):
All are are accepted with a claim number, at no cost to you.

Worker's Compensation Cases:
Accepted on a case-by-case basis, and subject to authorization by the Workers Comp Company. It is generally necessary to have a prescription from your case physician. Call us to find out more.

Acupuncture Insurance Benefits Check Form

* Indicates required field

Name *

First

Last

Date of Birth *

Email *

Phone Number *

Preferred Communication *

Phone Email

Insurance Company *

ID or Member # *

Group # *

Main Person on Policy? *

Yes No

Name of Main Policy Holder *

Date of Birth *

Relationship *

Submit information

Insurance Billing

Acupuncture Insurance Benefits Check Form

(541)241-3135 461 NE Greenwood Ave, Ste A, Bend, OR 97701 info@EvolutionaryMed.com