Get Printable Insurance Verification Form

Filling out the Printable Insurance Verification Form online is a crucial step to ensure your child's coverage during visits to Sierra Pediatrics. This guide will walk you through each section of the form to help you provide accurate and complete information.

Follow the steps to successfully complete your form

1. Press the ‘Get Form’ button to access the insurance verification form and open it in your preferred online editing tool.
2. Begin by entering the patient's name in the designated field. Ensure the name is spelled correctly to avoid discrepancies.
3. Input the date of birth (DOB) for the patient. Use the format MM/DD/YYYY for clarity.
4. Fill in the primary insurance details. This includes the insurance company name and the insured's name, which should match the policyholder’s name.
5. Enter the address of the insurance company, ensuring that the city, state, and zip code are accurately included.
6. Provide your home address in the following section. It should include the complete address and city, state, and zip code.
7. Complete the insurance phone number field and your home phone number for contact purposes.
8. Fill in the policy number and group number as listed on the insurance card. These numbers are critical for claims processing.
9. Indicate the insured's date of birth in the appropriate field.
10. Select the sex designation (M or F) as applicable and provide your initials as required.
11. If applicable, repeat the process for the secondary insurance policy. Include the same pertinent details as the primary insurance.
12. If you have more than one insurance policy, ensure to complete the coordination of benefits section by providing initials.
13. Acknowledge receipt of the financial policy by providing your initials, and understand your financial responsibilities.
14. Finally, sign the form as the parent or guarantor, and add the date of signing.
15. Once you have completed the form, you can save your changes, download, or print the document for submission.

Complete your Printable Insurance Verification Form online today to ensure seamless pediatric care.