Verify your Benefits:

Fill out the form below to receive an estimation of your insurance coverage.

*We cannot accept HMO insurance plans as we are not hospital affiliated. We apologize for any inconvenience.

**Insurance billing for treatment only available for the following insurance holders:

  • Alliance PPO

  • Allied Benefits Systems PPO

  • Beacon Health Systems PPO

  • Beacon Health Options (formerly ValueOptions) PPO

  • Cigna PPO

  • Blue Choice PPO

  • Blue Cross and Blue Shield PPO

  • Aetna PPO

  • Magellan Behavioral Health PPO

 

Please complete the form below

First and Last Name *
First and Last Name
Date of Birth *
Date of Birth
Primary Insured First and Last Name (if under parents)
Primary Insured First and Last Name (if under parents)
Primary Insured's Date of Birth (if under parents)
Primary Insured's Date of Birth (if under parents)
May I leave a message if I cannot reach you? *
Please select your preferred method of contact
Please enter a brief description of why you are seeking treatment.