Benefits Investigation

To best understand your child’s individual health benefits and any potential out of pocket patient responsibility, our team will conduct a benefits investigation on your behalf prior to your first appointment. To get started, please complete the form below.

The benefits investigation could take between 3-5 business days. Once information is received from your child’s health insurance company, our team will reach out via email with your child’s health benefits attached. At that time you can confirm whether or not you would like to move forward with your As You Are appointment. Please note that no charges will occur until after your child’s first appointment with a physician.

Patient Name(Required)

First Last

Patient Date of Birth(Required)

Insurance Name(Required)

Insurance ID #(Required)

Insurance Group #

Insurance Phone # (located on the back of the card)(Required)

Guardian Phone #(Required)

Guardian Email(Required)

Informed Consent for Electronic Communications

Consent(Required)

I hereby give my consent to receive E-Communications. I understand I can revoke this consent at any time by contacting [email protected] or calling (866) 219-8595.

Would you like to receive text messages?(Required)

yes

By selecting this checkbox, you authorize Quadrant Biosciences Inc., its subsidiaries and any of its affiliated entities, including As You Are, to deliver SMS messages using an automatic dialing system and you understand that you are not required to opt in as a condition of purchasing property, goods or services. Notifications could come from BESEEN (237336), RESULT (737858), 206-828-1585 or 680-207-2699. Message frequency varies. Text HELP to BESEEN (237336) or RESULT (737858) for help. Text STOP to BESEEN (237336) or RESULT (737858) to end. Msg&Data Rates May Apply. By opting in, you are agreeing to the Privacy Policy, Mobile Terms and Conditions, and the HIPAA Texting Informed Consent.

Call our Support Team at 866-219-8595.

We are available to answer any of your questions between 7:00 AM and 7:00 PM Eastern.

We accept many major insurance plans. However, participation may vary by state and each child’s health insurance benefits.

We work with commercial insurance plans, TRICARE, traditional state Medicaid plans and managed care partners. We are constantly expanding our relationships as we grow. And, as a part of our process, our support team will review a child’s insurance benefits with their parent or guardian before the first appointment.

Benefits Investigation

Call our Support Team at 866-219-8595.

We accept many major insurance plans. However, participation may vary by state and each child’s health insurance benefits.

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