Insurance Billing Information

Insurance Billing

We are in network with:
Providence, Regence (Blue Cross & Blue Shield), Pacific Source*, United Health Care, First Choice Health, Tri West (VA), and More.

Benefits must be verified by our office before insurance is accepted in lieu of full payment.
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 *Community Solutions (Medicaid). 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.
Call us to find out more.

Workers 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