Insurance Form

AAC is not contracted with any medical commercial insurance companies.  As a courtesy, we will submit a claim to your medical insurance carrier on your behalf.  However, we are unable to submit claims to the following companies: TRICARE, BCBS FEDERAL PLANS, KAISER AND PROVIDENCE.

For more information on commercial insurance, Medicaid, or our self-pay rates, please click here or contact our office.

If you would like us to submit a courtesy claim to your commercial insurance carrier, please complete the form below.  As a reminder, we cannot submit claims to TRICARE, BCBS FEDERAL PLANS, KAISER AND PROVIDENCE. This information will be emailed directly to AAC’s business office and we will contact you with any questions or if we need more information.

PLEASE FILL OUT THE MEDICAL INSURANCE INFORMATION PAGE AND IT WILL BE EMAILED DIRECTLY TO AAC. WE WILL CONTACT YOU IF WE HAVE ANY QUESTIONS OR NEED MORE INFORMATION.