Dena Joyce Acupuncture

Tailor-Made Holistic Health Care

(646) 391-1717

Insurance Verification

If you would like to check your insurance benefits before scheduling an appointment, please fill out the form below. Be advised that form submissions will be electronically submitted through a non-HIPAA compliant server and there is a chance that the information could be accessed by outside parties. If you wish to ensure your information is secure you may call 646.391-1717 to verify benefits.

Name

First Name

Last Name

Patient Date of Birth

YYYY

Email Address

Name of Primary Insurance Company

ex. Aetna, United Healthcare, Empire, etc

Type of Insurance

ex. HMO, PPO, Anthen, etc.

The ID number on your insurance card

Insurance provider phone number

Located on the back of insurance card

Covered under someone else's insurance plan?

Select "yes" if you are covered under someone else's insurance

Name of Insured Party

Name of the primary policy holder

Your Relationship to Insured

ex. spouse, domestic partner, child

Date of birth of the primary policy holder

Message

Any other information. Please let us know if your treatment is related to an auto-accident/no-fault, personal injury or workers compensation.