Which of the following best describes your situation?
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I have Medi-Cal, Medicare, Medicaid, IEHP or Kaiser with no financial resources
I have private insurance from my employer, university, family member or indemnity plan
I have financial resources and exploring cash pay options
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Thank you for your interest.
In order to find the specific number for your needs, please look at the back of your insurance card and locate the number next to Member Services. If you give them a call, they will be able to give you a list of comprehensive resources within a 25-50 mile range of where you're currently located. Hope that helps!
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Verification of Benefits Form
Please enter your insurance information below and one of our Admissions Specialists will be in touch shortly.
Patient's Name
*
First Name
Last Name
Insurance Provider
*
Member ID Number
*
Date of Birth
*
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Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
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No Insurance? No Problem!
While we do accept many insurance programs, our goal is to keep a person’s lack of insurance from being a roadblock to the quality healthcare he/she deserves. We offer affordable self-pay options.
Patient's Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Monthly Budget for Treatment
*
Email Address
example@example.com
Submit
Should be Empty: