In Network:

Moda

Regence BCBS of Oregon

United Healthcare

Providence

Anthem BCBS

Cigna

Aetna

Pacific Source: provider is out-of-network. Some plans do cover out of network treatments, please complete form below so we can look up the specifics of your plan and let you know.

For plans with in-network coverage, the clinic will bill insurance on your behalf. Please complete Insurance Verification form below or contact clinic directly to provide information necessary to check benefits. The clinic will verify your benefits and contact you before your first appointment.

For out-of-network plans, there are two routes. For those with out-of-network treatment benefits, the clinic will bill insurance on your behalf. For those that do not have treatment benefits, payment is due at time of service. Unsure of your plan coverage? Fill out form below and we’ll let you know.

Verified benefits doesn’t guarantee coverage.

Time of Service discount offered to self-pay patients.

Insurance Verification Form

Patient Name

Enter legal name, as shown on insurance.

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Preferred Communication Method:

Phone

Insurance Company Name

Health Plan Name

ID or Member Number

Group Number

No group #? Put NA

Main Person on Policy?

Yes

Main Policy Holder Name

Complete the following three fields only if the patient is not the main policy holder

First Name

Last Name

Main Policy Holder Date of Birth

YYYY

Relationship

Message

Anything else you'd like to tell us or ask about?