Please use the form below to submit the front and back photo copies of your insurance card.
Insurance information given to PCNH by your insurance company is not a guarantee of payment. This includes information provided about covered treatments, patient responsibility, copays, coinsurance, deductibles, referrals, and pre-authorizations. Please remember your insurance policy is an agreement between you and the insurance company and it is your responsibility to pay for any balance not paid or covered by insurance. Any charges that are not covered by the given insurance company will be billed to you.
