Thank you for your application we will contact you within the next 24 hours.
IMPORTANT: Before we can verify your coverage with your insurance company, we need a copy of the front and back of your insurance card. Please scan or snap a picture of both sides and submit them here or email email@example.com If you require assistance, please call us at 516-229-1194 ext 207 or email us.
A quote of benefits and/or authorization does not guarantee payment. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at the time of service**you will always be solely responsible for letting your provider know about changes in insurance and/or payment status of services. Any services not fully covered by insurance will be the responsibility of the patient/ family/ caregiver
Privacy Disclaimer*Achievement Behavior will never sell your information to any third-party person we are committed to protecting your personal information and your right to privacy. please contact us at firstname.lastname@example.org if you have any questions
Privacy guarantee: We do not share your information and will contact you only as needed to provide our ABA service.