Thank you for Interest in Tree of Life Birth & Gynecology. Please complete the below forms in their entirity in order to assure proper insurance billing and estimated out of pocket expenses to you. We will review financials with you at your appointment.
STEP1 - New Patient Registration
PLEASE FILL OUT our online registration form
before your first visit.
STEP 2 - Well Woman Intake Paperwork
PRIOR TO YOUR FIRST VISIT, Please Download and fill out THIS INTAKE paperwork to bring with YOU.
Insurance & Verification of Benefits
AFTER WE RECEIVE YOUR REGISTRATION YOU WILL RECEIVE A CONFIRMATION EMAIL AND A MEMBER OF OUR STAFF WILL CONTACT YOUR INSURANCE CARRIER. WE WILL PROVIDE YOU WITH A DETAILED EXPLANATION OF YOUR BENEFITS AND PREPARE YOUR PAYMENT AGREEMENT AT THAT TIME. THE AGREEMENT WILL BE PRESENTED TO YOU AT YOUR NEXT APPOINTMENT.
Verification of Benefits (VOB) for your current insurance coverage plan & the completed Payment Agreement (PA) will be done within 2 weeks of signing up with Tree of Life.
The information obtained on the VOB is not a guarantee of coverage. TOL is not responsible for deviations from the insurance coverage described within the VOB form. You may consult your plan details provided by your insurance company for further clarification on plan limitations.
TOL will obtain insurance benefit information once per Patient Registration Form submitted. If your policy changes for any reason, including renewal periods, and you would like to receive an update on coverage, a second Patient Registration Form will need to be submitted to TOL via the website link. If you would like a quote of benefits for any secondary insurance not noted on the original Patient Registration Form, you will need to submit that separately on our website.
Please keep in mind that the payment agreement was completed based on your desired place of delivery; should this change an updated payment agreement will need to be made at that time. Also, remember that your deductible(s) (both in and out of network) will need to be satisfied each plan coverage year regardless of the provider you choose and the place you plan to deliver. Your deductible(s) will be checked in your third trimester and your payments will be adjust based on what is satisfied at that time.