Lotus Counseling Services, PLLC

Lotus Counseling Services, PLLC Request an appointment

Billing & Payment

Administrative

1 Appointment info

3 Contact information

How do you plan to pay for services?

IF USING INSURANCE, we are unable to approve appointment requests without the front and back of your insurance card uploaded below.

Out of pocket ($150/session) Anthem PPO Blue Cross Blue Shield PPO Aetna PPO or POS Cigna PPO Aetna EAP Cigna EAP CCA EAP Indiana traditional Medicaid (not through Anthem, MD Wise, or Caresource)

Insurance card upload

Upload a photo of your insurance card

What is your relation to the primary insured?

I am the primary insured. My spouse is the primary insured. My parent is the primary insured. I am not using insurance.

What is the name of the primary insured? (REQUIRED to bill insurance)

What is the date of birth of the primary insured? (REQUIRED to bill insurance)

Do you have another insurance policy?

If you have more than one insurance policy, we will reach out to you via email to collect the additional information. It is important that you tell us if you have another policy, even if you do not plan to use it.

Yes, I have another insurance policy. No, I do not have another insurance policy. I am not using insurance.

If using EAP services, please provide the following information: 1. Name of EAP provider 2. Phone number of EAP provider 3. Authorization code 4. Number of sessions authorized 4. Authorization dates

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.