Verification of Benefits

Verification of Benefits (VoB)

The following is information required for LEAPS AND BOUNDS THERAPY to bill your insurance. This information is required before services can begin. The information obtained by Leaps and Bounds Therapy from your insurance plan is not a guarantee of payment and all services are subject to the terms and agreement of your plan, at the time services are rendered. Any pre-certifications will be initiated by Leaps and Bounds Therapy. We strongly recommend calling your insurance plan with any questions you may have. PATIENT RESPONSIBLE FOR ALL DEDUCTIBLE AND OUT-OF-POCKET EXPENSES AS DETERMINED BY PLAN .

INFORMATION OBTAINED ON THIS FORM BY LEAPS AND BOUNDS THERAPY AND ABILLINGCO IS NOT A GUARANTEE OF COVERAGE. YOUR PROVIDER, IS NOT RESPONSIBLE FOR DEVIATIONS FROM THE INSURANCE COVERAGE PROVIDED BY YOUR INSURANCE COMPANY FOR CLARIFICATION ON PLAN LIMITATIONS. IT IS HIGHLY SUGGESTED FOR YOU TO CALL AND LEARN YOUR PLANS COVERAGE

Client information

Client's Name(Required)
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Client's address(Required)
Primary Caregivers Name(Required)

Primary insurance information

Subscriber's Name(Required)
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