Insurance

Insurance Information

Please provide your insurance details to help us process your visit efficiently. All information is confidential and secure.

Insurance Plans We Accept

We accept most major insurance plans. Below is a list of providers we work with.

Excellus BC/BS

Blue Cross Blue Shield

Cigna

Cigna Health Insurance

United Healthcare

UHC

Aetna

Aetna Health Plans

Medicare

Federal Health Insurance

Fidelis Care

Florida State of Health

Don't See Your Insurance?

If you don't see your insurance provider listed, please call us at (607) 731-3136. We may still be able to accept your plan or offer competitive self-pay rates.

Insurance Details

Please complete all fields marked with an asterisk (*)

Insurance Status

Do you have insurance? *

Yes No

Do you have secondary insurance?

Yes No

Primary Insurance

Insurance Provider *

Policy Number *

Group Number

Subscriber Name *

Subscriber Date of Birth

Relationship to Subscriber *

Secondary Insurance (if applicable)

Secondary Insurance Provider

Secondary Policy Number

Secondary Group Number

Upload Documents

Please upload clear copies of your documents. Accepted formats: JPG, PNG, PDF. Max 5MB per file.

Driver's License (Front)

Click or drag to upload front of driver's license

Driver's License (Back)

Click or drag to upload back of driver's license

Primary Insurance Card

Primary Insurance Card (Front)

Click or drag to upload front of primary insurance card

Primary Insurance Card (Back)

Click or drag to upload back of primary insurance card

Secondary Insurance Card (if applicable)

Secondary Insurance Card (Front)

Click or drag to upload front of secondary insurance card

Secondary Insurance Card (Back)

Click or drag to upload back of secondary insurance card

Additional Notes or Comments

Need to provide patient information first?

Add Patient Information

Questions About Insurance?

Our team can help verify your coverage and explain your benefits before your virtual visit.

Call (607) 731-3136 Schedule a Visit