Insurance Verification

Your cost of treatment will depend mostly on your health insurance and policy coverage details. Please fill out the form below and one of our admissions coordinators will call you back promptly with the information you need!

Insurance Verification Form

Here are a few tips for completing the insurance verification form on this page:

– Step 1 Fill in as much information as possible. Don’t worry about any parts you aren’t sure about; just fill in what you can.
– Step 2 After you submit your information, we will work diligently with your insurance carrier. This generally takes 15 – 60 minutes.
– Step 3 Once we have all the information, we will contact you to discuss your coverage and options and help you with the next steps.

Patient First Name

Patient Last Name

Patient Birthday

Primary Insured First Name

Primary Insured Last Name

Primary Insured Birthday

Address

Address Unit/APT/Suite

City

State

Zip Code

Primary Insured Phone Number

Additional Phone Number

Insurance Provider

Insurance ID Number

Insurance Group

Type of Plan

Contact Numbers

I agree to receive marketing messaging from Revive Health Recovery at the phone number provided above. I understand I will receive 2 messages a month, data rates may apply, reply STOP to opt out.

Insurance Verification

Insurance Verification Form

Here are a few tips for completing the insurance verification form on this page:

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Our Accreditations

Insurance Verification

Insurance Verification Form

Here are a few tips for completing the insurance verification form on this page:

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