Insurance Verification

Verify Your Insurance

If you would like to use your insurance for our residential treatment, please submit your information for verification. All information is held confidential. Some of the insurance companies we work with include, but are not limited to:

logo_insurance Verifying your insurance is very important in determining your benefits and what will be covered. Fill in all required fields of the form below and we will notify you immediately when we have verification.

Verify Your Insurance

Patient Name:*
Patient Date of Birth:*
DD slash MM slash YYYY
Subscriber Name:*
Subscriber Date of Birth:*
MM slash DD slash YYYY
Your Email:*
Phone Number:*
Address:*
Street Address City State ZIP Code
Insurance Provider:*
Insurance Phone:*
Insurance ID #:*
Group ID #:*
Type of Plan:*
Comments:
Name
This field is for validation purposes and should be left unchanged.