Concierge Out-of-Network Benefits Lookup

1
Are you on Medicaid, Medicare, or does your insurance card indicate "HMO" or "EPO?"* This field is required.
YESNO
2
Please note that your insurance does not include out-of-network benefits.

However, we offer a range of affordable therapist options and, even if we aren't the right fit, we're happy to provide referrals to help you expand your search for a therapist who can help.

Please feel free to reach out to clientcare@claritytherapynyc.com for personalized resources. You may exit out of this screen to close the form.
3
Please check my benefits for* This field is required.Select all that apply
Individual Therapy
Couples Therapy
Family Therapy with patient present
Family Therapy without patient present
Other (e.g. Testing)
4
Are you seeking a benefits check for testing services?* This field is required.e.g. ADHD testing, IQ/Learning Disability testing, psychological evaluations, etc
YESNO
5
Given the range of variables involved, we’re unable to verify out-of-network benefits for testing directly.

We recommend contacting your insurance provider for the most accurate information.

To assist with this, please refer to this page for a script of helpful questions to ask during your call.

Thank you for your understanding!
6
Email
example@example.com
7
Therapist NameIf you don't have a therapist yet, simply skip this question
Please Select
Please Select
Amy Schell
Ariel Zeigler
Begoña Núñez Sanchez
Carole Taylor-Tumilty
Caryn Moore
Christina Mancuso
Courtney Cohen
Daniel Rich
Elena Beharry
Eliza Chamblin
Fanny Ng
Gary Brucato
Gavin Shafron
Janel Coleman
Jen Oddo
Joanna Kaminski
Jessa Navidé
Josh Watson
Justin Yong
Karen Kaur
Kristin Anderson
Logan Jones
Lucas Saiter
Madeleine Phelan
Monica L. Amorosi
Nancy Lumb
Nicole Maselli
Peter Gradilone
Raquele Williams
Regina Musicaro
8
Client Name* This field is required.
First Name
Last Name
9
Client date of birth* This field is required.
Date
Month
Day
Year
10
Zip code* This field is required.
11
State of your address* This field is required.
Please Select
Please Select
NY
NJ
CT
AL
AK
AZ
AR
CA
CO
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NM
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
12
Client relationship to member/insured* This field is required.
Self
Spouse
Child
Other
13
Name of member/insured (if different from client as shown on insurance card)* This field is required.
First Name
Last Name
14
Date of birth of member/insured (if different from client)* This field is required.
Date
Month
Day
Year
15
Member ID* This field is required.Please enter your member ID as it appears on your insurance card
16
Group Number
17
Name of Insurance Company* This field is required.
18
Provider Customer Service Phone* This field is required.Please enter the phone number found on your insurance card
Area Code
Phone Number
19
Upload an image of the front and back of your insurance card* This field is required.
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