|
|
 Insurance Massage
|
|
|
|
“Our bodies communicate to us
clearly and specifically,
if we are willing to listen to them.”
~ Shakti Gawain
Medical Massage Therapy

Please allow 48 business hours for us to get back to you regarding your benefits.

FULL NAME
PHONE NUMBER
EMAIL ADDRESS
DATE OF BIRTH
INSURANCE PROVIDER
ID NUMBER INCLUDING PREFIX (if applicable)

CUSTOMER SERVICE/PREAUTHORIZATION NUMBER
(located on reverse side of insurance card)
QUESTIONS OR COMMENTS

If you do have massage benefits through your insurance plan, please be aware that we will require a referral on file to begin billing your insurance.  If you have any questions regarding your plan, please call us. 

Please note your referral must state treatment frequency, duration and ICD-9 code(s)

Example: Deep tissue massage 2 x a month for 3 months for back pain 724.5, and headaches 784.0.

Checking of benefits is not a guarantee of payment by your insurance company, the client will be invoiced the full billed amount if applied toward annual deductible or if massage benefits have been met for each calendar year. 
Cancellation Policy
If you are unable to make your scheduled appointment, kindly give 24 hours notice to prevent a 50% service charge and/or prevent your gift card from being voided.
360.405.0293 // 2109 E. 11th Street, Bremerton // Just off the bridge in Manette
© 2010-2011 Rejuv, LLC. All rights reserved.