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* 1. What is your name? (optional)

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* 2. In what state or U.S. territory do you live?

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* 3. What is your professional discipline?

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* 4. What is the average number of patients/clients you see on a monthly basis?

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* 5. Is your practice cash only?

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* 6. If yes, do you provide a superbill (an itemized bill reflecting services rendered and appropriate billing codes) for your patients so it can be submitted for health insurance reimbursement?

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* 7. If you provide patients/clients with a superbill or submit claims for them, how often are your patients successful in obtaining reimbursement for your services from their health insurance provider?

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* 8. If your services were reimbursed by a health insurance plan, would you pursue credentialing to become part of a health insurance payer network?

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* 9. Are you credentialed as a PPO in-network provider and/or a HMO provider?

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* 10. Have you been denied credentialing from a health insurance plan before, or after January 1, 2014?

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* 11. Have your patients/clients been denied reimbursement by a healthcare plan for services you rendered before, on or after January 1, 2014?

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* 12. Have you experienced any of the following issues for services you provided on or after January 1, 2014?

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* 13. Any specific healthcare plans you've had difficulties with since January 1, 2014?

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* 14. If you or your patients are willing to speak with us in further detail regarding any denials of insurance services since January 1, 2014, please provide contact information here:

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* 15. Do you collaborate with local MDs/DOs?

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* 16. Do you partner with local hospitals?

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