Insurance Billing Information

Insurance Billing

We are in network with:
Providence, Regence, Pacific Source, United Health Care, First Choice Health, Multi Plan, Tri West (VA), and More.

Benefits must be verified by our office before insurance is accepted in lieu of payment.
Call (541)241-3135 for a free benefits check, or fill out the form below.

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 with questions, or to find out more.

Acupuncture Insurance Benefits Check Form

* Indicates required field

Name *

First

Last

Date of Birth *

Email *

Phone Number *

Preferred Communication *

Phone (most secure) 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