Please fill out the form below. Insurance verifications can take 3-5 business days. We will contact you by your preferred method.
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Please keep in mind that I ONLY bill to BCBS, and only when it is the Primary Insurance on file.
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Please do not submit Medicare insurance, I am not able to bill to them. There is a different and more affordable option for Medicare patients. Information can be found here.
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Please note: By submitting information through this form, you will be asked to acknowledge and consent that this is not a HIPAA-compliant form of communication and that the confidentiality of your information may not be fully protected. If you prefer to use a HIPAA-compliant platform to submit insurance information, you may create a profile on the Jane app (HERE) and fill out your insurance information within the portal.
