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EZTelePsych

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Billing & Payment

Administrative

3 Contact information

Payment method

How do you plan to pay for the appointment? (Not accepting Medicare or Medicaid plans at this time)

Out of pocket (selfpay) Insurance

Insurance details

Blue Cross Blue Shield of Michigan PPO Blue Cross Blue Shield - All other PPO (comercial plans) Blue Care Network Anthum Blue Cross Carelon Behavioral Health Aetna Cigna United HealthCare (UHC, UMR, Optum) Priority Health HAP (Health Alliance Plan) Aetna Oxford Oscar Health Other NA - If Self-Pay, upload a blank page for insurance below

Insurance card upload

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Primary policy holder

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Client (Patient) Client's spouse Client's parent Other

If the Primary Policy holder is other than Patient Please provider their information below: Name, Address, Phone.

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

Mohammed Joz, PMHNP-BC

Tel: 248.983.1070 . Fax: 248.780.3805

Notice of Privacy Practices

No Surprises Act

You have the right to receive a Good Faith Estimate of what your services may cost.

Main Location

455 E Eisenhower Pkwy Suite 300-1016
Ann Arbor, MI 48108-3324

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License Agreement

Help Center

THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.