Insurance Verification

Insurance Verification

We accept most insurances out of network*. We can verify your benefits and calculate your co-pay, usually within 90 minutes during standard business hours.

*Senders Name (required):

*Spenders Email (required):

Senders Phone Number:

Patient Name:

Patient Phone:

Patient Date of Birth:

Insurance Subscribers Name (if different than patient):

Date of Birth (if different then patient):

Primary Insurance Carriers Name:

Group ID Number

Member ID Number

Policyholder Employer The Group Plan Is Under:

Policyholder address:

Insurance Companies Phone Number:

Your Message

*unfortunately Medicaid and Medicare do not cover our treatment services.