IMPORTANT: Before we can verify your coverage with your insurance company, we need a copy of the front and back of your insurance card. Please scan or snap a picture of both sides and submit them in this form or to firstname.lastname@example.org. If you require assistance, please call us at 845-863-5208 or email us.
A quote of benefits and/or authorization does not guarantee payment. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at the time of service. *** You will always be solely responsible for letting your provider know about any changes in insurance and or payment status for services. Any services not fully covered by insurance will be the responsibility of the patient/family.
Privacy Disclaimer: StarbrightAba will never sell your information to any third party person we are committed to protecting your personal information and your right to privacy.