INSURANCE VERIFICATION

Insurance Verification

Austin Quan Yin only accepts in-network insurance for the following providers: Aetna, Blue Cross Blue Shield, United Healthcare, Humana, Multi-Plan Network, Tricare, and Triwest.

Insurance Company*

Name*

Field Name

Email*

Phone Number*

Date of Birth*

Name of insured (if different)

Field Name

Date of Birth of the Insured (if different from above)

Address of the Insured*

Field Name

Employer*

Policy ID*

Group ID*

Insurance Card File (you must upload a clear, legible photos of the front and back of your insurance card)*

Drag files here or choose files

Do you have an appointment scheduled?

Yes

No

If so, when?

Provider

Reason for Appointment

Subject

I understand that information regarding my insurance verification could change at any time. *

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CONTACT US

Information

Austin Quan Yin

(512) 374-9800

5609 Adams Ave Suite B, Austin, TX 78756

Name*

Phone*

Email*

Message

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