Will my insurance cover Rehab?

Cost of rehab can be as little as "free" for some treatment centers to over a $1000 a day for others. If you or loved one has insurance what may be important is what your "out of pocket" cost will be. We can check with your insurance company and give you an idea of that cost by filling out the form below.

Your information will remain confidential and you will not be under any obligation. If you have any questions do not hesitate to call us at 877-655-2590.


Name:
Phone:
Email:
Address 1:
Address 2:
City:
State:
Zip code:
Age:


Comments or Questions:
Drug being used:
Payment Method:
Do you need transportation?
Do you have insurance? Yes
Your insurance Provider:
Patient Name:
Patient Date of Birth:
Policy Holders name:
Policy Holders DOB:
Relation to patient:
Insurance ID number:
Insurance phone number:
Have you have drug or alcohol treatment before? Yes