Insurance Reimbursement Information

Health Insurance

Head lice removal services may be covered by your health insurance provider. LouseCalls can provide you with the proper diagnostic codes and paperwork required by insurance companies for reimbursement. Please check with your provider for coverage eligibility.

Flexible Healthcare Spending Account

Most flexible spending accounts cover head lice removal services. LouseCalls also accepts most flexible spending account credit cards for payment.

Insurance Reimbursement Form

Name of Treated Client #1*
First Last
Name of Treated Client #2
First Last
Name of Treated Client #3
First Last
Name Of Responsible Party/Parent/Guardian*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Date Of Service*
MM slash DD slash YYYY
Total Amount Paid*
Payment Method*
- Check
- Credit/Debit Card
- Cash
Special Instructions or Additional Names
Please allow 2-3 weeks to process
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