B.E.S.T. Chiropractic Clinic / Dr. Yoshio Homma, D.C.
Please fill out the form below to verify your insurance coverage.
We accept most of health insurances.
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【Fee Schedule】 |
First Examination and Treatments or Re-Examination and Treatments $120 and up Regular treatment $70 and up • Fees may vary by treatments provided ● Each insurance plan has a different coverage and policy. ● Your health insurance may not cover for Chiropractic care. ● We do not accept Medi-Cal of California State.
This form is ONLY FOR CHIROPRACTIC |
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Insurance Plan / Policy* | |
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* | Subscriber ID number |
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* | Subscriber's Name |
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| Medicare is generally for people over 65 |
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Relation to the subscriber* | |
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【Patient's Condition】 |
Reason for treatment/examination/visit* | |
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Which part of your body?* | |
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Work Related Injury? (Workers Compensation)* | If Yes, you must have a claim number from your manager/HR of your company before visiting our clinic. |
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Auto Accident Injury? | If Yes, your auto-insurance is primary insurance therefore, most likely we will claim it to the auto insurance |
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Which language do you prefer to use?* | |
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We will call you to confirm your chiropractic coverage within 48 hours. |