AIBW Insurance Verification System

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New Verification Request

Patient's Full Name *

Date of Birth *

Phone Number

Email Address

Insurance Company Name *

Policy Holder's Full Name (if different from patient)

Policy Holder's Date of Birth (if different from patient)

Policy Number *

Group Number (if applicable)

Is this a new insurance policy?

Preferred Contact Method for Updates

📄 Demo Mode

This is a demonstration system. All verification results are simulated and no real PHI is processed.

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✅ Insurance Status: Active

Copay

$25

Deductible Remaining

$560

Plan Type

PPO

Notes

This is a DEMO verification