Chiropractic Care Not Covered Tools > Insurance Verification Type > Chiropractic Care Not Covered Today's Date* Date Format: MM slash DD slash YYYY Patient Name* First Last Phone*Email* Clinic*Choose a ClinicBalanced Living ChiropracticComplete Balance ChiropracticCoulee HealthErickson ChiropracticHonchel ChiropracticKaizen ChiropracticNemitz ChiropracticTruhlsen ChiropracticTruhlsen Chiropractic-HendricksRichard Wilson DCWeber ChiropracticWW AppletonWW BeavertonWW BloomingtonWW Burr RidgeWW FitchburgWW Flathead ValleyWW Fort MillWW Grand RapidsWW Green BayWW JacksonvilleWW LargoWW LouisvilleWW MequonWW North PhoenixWW PensacolaWW RockfordWW SpringWW WaukeshaWW Woodbury (Empower Health)Name of Insurance CompanyChiropractic Care Not CoveredUpon checking with the patient's insurance company, the insurance company explained to us that the patient does not have chiropractic care as a covered benefit. This patient will need to be a cash patient. Thank you.Additional CommentsDisclaimer When we call on a patient's insurance and verify benefits, it is not a guarantee of payment by the insurance company and may vary according to the patient's individual plan when the actual claim is submitted. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member's contract at time of service. The patient responsibility amount provided is an estimate of cost. The patient must understand that their health insurance company may deny payment for the services received. The patient must understand that it is ultimately the patient's responsibility to contact their insurance if they want to know exact chiropractic benefits.Need help understanding this document? Watch this short video on Chiropractic Care Not Covered!