Insurance Coverage Not Active Tools > Insurance Verification Type > Insurance Coverage Not Active Today's Date* MM slash DD slash YYYY Patient Name* First Last HiddenPhone*HiddenEmail* 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 Company Insurance Coverage is not activeUpon checking with the patient's insurance company, the insurance company explained to us that the patient does not have active insurance coverage at this time. Please check with the patient to confirm if this is true. If the patient has different insurance coverage, please provide us with this information so that we can do an insurance verification with the new insurance. 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 Insurance Coverage Not Active!
