Insurance Verification Form

Many of the treatment centers we work with accept insurance. In some cases it can cover up to the full cost of addiction treatment. By filling out our insurance verification form we can match your benefits with providers who work with your insurance. One of our Next Step insurance specialists will get back to right away with your options.

    Patient Name *

    Patient Date of Birth *

    Subscriber Name *

    Subscriber DOB *

    Your Email *

    Address *

    City * State Zip Code *

    Phone Number *

    Insurance Provider *

    Insurance Phone *

    Insurance ID # *

    Group ID # *

    Type of Plan *

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