Insurance Request Form | Austin Texas - Acupuncture Plus

Insurance Coverage Request Form

Please take a moment to fill out this insurance form.
We will have our insurance specialist check your benefits.
You should hear from us within 24-48 hours.
Or, please feel free to call us at 512-453-5352.

* Indicates required field

Patient Name *

First

Last

Patient Date of Birth mm/dd/yyyy *

Patient Address *

Patient City, State *

Patient Zip Code *

Patient Phone # *

Patient Email *

Primary Insurance Holder Name (on card) *

First

Last

Primary Holder DOB mm/dd/yyyy *

Relationship with Primary Holder *

Insurance Company Name *

Insurance Company Phone Number *

Insurance ID # *

Insurance Group # *

Comments/Questions *

Submit

Attention, if you plan to use your insurance benefits:

When acupuncture coverage exists under your plan, the following are common restrictions and/or limitations that may or may not apply to your plan:

Aetna:
Only covers acupuncture if medically necessary for the following specific reasons:
Nausea & vomiting, migraine, headache, knee pain, lower back pain.

Aetna does not cover acupuncture for any other conditions, because it is consider experimental and investigational.

BCBS:
Only covers for pain.

BCBS does not cover acupuncture for any other conditions or diagnosis except pain (headache, lower back pain, knee pain etc.) because acupuncture is considered experimental and investigational by BCBS.

United Healthcare (UHC):
Only covers acupuncture for pain (headache, lower back pain, knee pain etc.) and nausea.

UHC Medicare: Only covers for low back pain.

United Healthcare does not cover acupuncture for any other conditions or diagnosis, because acupuncture is considered experimental and investigational.

Cigna: (We are not in network with Cigna, but work as out network.)
Only covers acupuncture if medically necessary for the following specific reasons:
Nausea & vomiting, migraine, headache, knee pain, lower back pain.

Cigna does not cover acupuncture for any other indication, because it is consider experimental and investigational.

Phone:
(512) 453-5352

Fax:
(512) 453-5318

Email

Hours

Phone: ​(512) 453-5352Fax:(512) 453-5318

Email

Hours

Phone:
(512) 453-5352

Fax:
(512) 453-5318