Are you the patient, or you are filling out the form for someone else (child, sibling, spouse)? *
I have called the behavioral health phone number on the back of my insurance card and made sure that Dr. Mudassar Tariq (NPI 1588895825, Tax ID: 81-3989390) is in network *
If you have out of network benefits, do you want to see Dr. Mudassar Tariq, MD using your out of network benefits?
My Plan type is
Do you have a deductible for mental health (A certain dollar amount (e.g $1500) that you will have to pay first before insurance starts paying.)) *
Who is the main subscriber on insurance (Primary insured)? *

In some HMO plans, the mental health is contracted out to third party insurance. You might not even be aware of the name of that insurance. Few examples are Magellan, compsych, Beacon, optum etc.  We are in network with Magellan and Compsych but not with Beacon and Optum. So we just want you to be aware, that if it is a third party carve out, even if your card says Blue Cross Blue Sheild, we might not be in network and you might be billed for full fee. If you are not sure, just google the behavioral/mental health phone number on the back of your insurance card, or you can call that number and ask them this question.