I certify that the information provided on this form is accurate and complete to the best of my knowledge. By signing below, I authorize Premier Birth Center and/or its designated billing partner, Larsen Billing Service (LBS), to verify my primary insurance benefits. Upon submission of this form, the information will be transmitted directly to Premier Birth Center. Our team will make every reasonable effort to verify your insurance coverage and obtain any required pre-authorizations for services when applicable. Please note, however, that verification of benefits and pre-authorizations are not a guarantee of payment. It is your responsibility to understand the terms of your insurance plan, including co-pays, deductibles, and any services not covered. Should your insurance provider deny coverage or payment for any service, you will be financially responsible for the associated charges.