INSURANCE VERIFICATION FORM Logo
  • Patient Billing Registration Form

    Please upload front & back of insurance cards & Photo ID for accuracy of verification of benefits. 

  • ***INSURANCE DISCLAIMER***

    Eligibility & Verification of benefits. 

    Thís is not a guarantee of payment, but an estimate. Actual payment and member responsibility are determined when claims are processed and may be different due to a number of factors including differences in services rendered, changes in patient eligibility, other payments made, provisions of the plan including recent amendments, applicable law, and other relevant factors.

    Policy Overview Payment at Time of Service" policy

    In an effort to improve the efficiency of our billing processes, reduce outstanding balances, and continue providing high-quality care, Noble Healthcare Solutions Practice Management is implementing a "Payment at Time of Service" policy. This means that all co-pays, deductibles, co-insurance, and any known patient responsibility amounts are expected to be paid in full at the time services are rendered.

    What This Means for Patients

    Insurance Verification: We will continue to verify your insurance coverage before your appointment.


    Cost Estimate: Our staff will provide an estimate of the expected payment based on your insurance plan at this time we will either invite you to the client portal to add your credit card information or send you a credit card form via email/or mail.


    Payment Methods: We accept a variety of payment methods including credit/debit cards, HSA/FSA cards, checks, and cash.


    Payment Plans: If you are unable to pay the full amount at the time of service, please speak with our billing department prior to your appointment to arrange a payment plan.

    • Medicaid/Medicare Patients: Patients with coverage through government programs will only be responsible for payments as dictated by their plans.

     

    We are asking if your insurance, or address change please contact the billing department to update us. 

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  • I agree that the Provider listed above billing department is authorized to submit insurance claims and follow up on insurance payments on behalf of my provider.

    For Billing or Insurance questions please call 616-303-0660 or email billing@noblehealthcaresolutions.com

     

    Mon-Wed 9am until 5pm Thursday 3pm until 7pm Fri 10 am unitl 2pm

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