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Name of Insured *
Name of Insured
Privacy *
This form collects your name, email, phone number, insurance provider, insurance policy number, date of birth and referred practitioner so we can look into your benefits. Your information is shared with our medical billing company in order to verify your coverage.

Source Wellness accepts most MAJOR medical insurance carriers that cover out of network Acupuncture benefits. Source Wellness is NOT a Medicare provider however if you have a secondary plan that covers out of network Acupuncture, this can be used once the verification shows approval.

Once your insurance has been verified, it is important for the patient to follow up to confirm the information that Source Wellness is given is correct. Your coverage will be explained to you once the verification has been completed by our medical billing department.

If you are interested in inquiring about your out of network benefits, please fill out the form below and we will get back to you once we have verification from your insurance carrier. If you prefer to submit your information by telephone, please call us at (845) 359-4767.