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In Network Request Form

Luna Medical > Contact Us > In Network Request Form

If you would like Luna Medical to become "in-network" for your insurance provider, please submit the form below.

* = required fields

* Insurance Company Name:

* Insurance Claims Address:

* City:

* State:

* Zip Code:

* Insurance Provider Customer Service Phone:

* Insurance Member Customer Service Phone:

Insurance Company







PLEASE NOTE: Today, December 13th, is the last day to submit orders for anything to be shipped in 2024 and be applied to 2024 benefits. We understand that there may be other deadlines you are used to but this year has been unlike any other and the demand is incredibly high and we want to make sure we give excellent customer service and we had to make tough decisions as a company for end of year demand. Those who had their benefits submitted prior to the 13th will be prioritized. We hope you understand and we thank you.