Insurance Verification

Thank you for submitting your insurance to our website. We strive to make the process as easy as possible for you and our client’s.  You can read more about our commitments and values here – https://nestlife.us/nest-life-identity-and-culture/.

  • Start Client Information
  • Insurance Information
  • Read Acknowledgement

Please complete all steps in this multi-step form to verify insurance information for services at Nest Life.
*data is saved as you progress (unless browser cookies/cache are deleted)

CLIENT INFORMATION

PARENT(S) INFORMATION

1ST PARENT NAME

2ND PARENT NAME


INSURANCE INFORMATION

PERSON RESPONSIBLE FOR BILL


INSURANCE PROVIDER

We will submit your claims, however we must emphasize that as health care providers, our relationship is with you, not your insurance company. Although we attempt to verify your ABA/Autism benefits with your insurance policy, please be advised this is only an estimate of your coverage based on the information given to us at the time of inquiry.

By signing below, you confirm that you understand:

It is your responsibility to inform us of any changes to your insurance policy so that your coverage can be re-verified prior to your appointment.

  • If your insurance policy requires a prescription from your primary care physician, it is your responsibility to have that faxed to our office prior to your appointment.
  • Not all services are a covered benefit with all insurance plans.
  • It is your responsibility to be aware of what service(s) is being provided to you and if it is not a covered benefit under your insurance policy.
  • You are responsible for any non-covered charges not payable by your insurance policy.
  • Although filing your insurance claims is a courtesy extended to you, all charges are always your responsibility from the date services are rendered.

We realize that temporary financial problems may affect timely payment of your account. If such problems do arise, we urge you to contact us promptly for assistance in the management of your account. If you have any questions or concerns about the information, please do not hesitate to ask us. We are here to help you.

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