Verify Your Health Insurance

If you have health insurance, please enter your information below to allow us to do a free verification of benefits to determine your out-of-pocket costs for your stay. ALL INFORMATION YOU SUBMIT IS CONFIDENTIAL:

Enter Patients Information

First Name

Last Name

Phone Number

Street Address

City

State

Zipcode

Select Gender

DOB

Enter Insurance Information

Primary Subscriber

Insurance Company

Insurance Phone

Group Number

Select Your Plan Type

Upload Your Insurance Card - Front & Back

Insurance Card (Front)

Insurance Card (Back)

Additional Information

Select Type Of Treatment

Comments / Brief Description of the Issue

Verify Your Health Insurance

Enter Patients Information

Enter Insurance Information

Upload Your Insurance Card - Front & Back

Additional Information

(888) 595-0235