OPTION 1: SELF-PAY -

I do not have insurance, or would like to bill my own plan for reimbursement (Not applicable to Medicare beneficiaries). We also offer payment plans.

OPTION 2: INSURANCE PAY -

My private insurance card describing coverage is included for billing. I understand that Coba Toxicology will bill my private insurance.

OPTION 3: WORKERS COMPENSATION -

Please bill workers compensation. I have filled out and included a Worker's Compensation Insurance Form