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Submit Insurance Card Back and Front Photos

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.

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    Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 2.
    • Please allow up to 3 business days to receive our communications regarding your insurance. If your application has been submitted over the weekend, which starts on Friday, 4:00pm PST, please keep in mind that the next business day is Monday to receive our communications. .