How do you plan to pay?
Please list your insurance company, plan name, member ID, and group number (if applicable). If you have secondary insurance, provide the same information for that plan and label each plan primary or secondary. If you are not the policyholder, include the policyholder’s full name, date of birth, and relationship to you. If you plan to pay privately, enter “Self-pay.”
Limited to 600 characters
Upload a photo of your insurance card
By selecting “I agree,” I authorize Vita Nova Psychiatry & Wellness to contact my insurance plan(s) to verify eligibility, benefits, and coverage, and to exchange information necessary for that purpose. I understand that verification is not a guarantee of coverage or payment. If I receive services, I am responsible for applicable copayments, deductibles, coinsurance, and other amounts I legally owe under my plan, applicable law, and the practice’s financial policy. Submitting this inquiry does not obligate me to receive services.
I authorize VitaNova Psychiatry & Wellness Nursing PC to contact my insurance plan(s) to verify eligibility, benefits, and coverage. I understand that verification does not guarantee coverage or payment. If I receive services, I am responsible for applicable copayments, deductibles, coinsurance, and other amounts I legally owe under my plan and the practice’s financial policy.
For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.