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Insurance Benefits Verification

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Insurance Company Name (required)

Verification/Benefit or Provider Phone Number (back of the card)

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If you are not the subscriber on the policy but rather a parent or spouse or other, please fill out the subscriber's information.

Subscriber Name

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By checking below you accept the following terms to authorize your benefits to be verified and understand that this process is only a verification of insurance benefits. If you need immediate help please call 911 or go to the nearest emergency room. The verification process can take 1-24 hours and is not assurance of availability for eating disorder treatment. This service is to assist you in finding out what your benefits cover for various levels of care. Speaking to a program professional to determine the appropriate level of care provided benefits allow is the following step. You have take the first step ~ Fantastic! Someone will get back to you shortly.