Insurance eligibility is based on specific member plan details. Submitting this information does not obligate payment. Please provide active and accurate insurance information. Failure to do so may result in you being responsible for self-pay. Additionally, you must disclose your coordination of benefits. Cortica will make every effort to determine eligibility and provide a cost estimate prior to services rendered. However, we cannot guarantee payment or verify that the eligibility of benefits conveyed to us or to you by your carrier will be accurate or complete. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member's contract at the time of service.