Please complete the below Eligiblity Checking Form in order to obtain an Out-of-Pocket Cost Estimate.

We use a third-party clearinghouse to first check if you are currently covered under an insurance plan and then to automatically determine your insurance information.

You do have the option of by-passing this Checker where you will need to supply your information.

All items required to perform the Eligibility Check are securely sent to the clearinghouse and processed with our system.