Insurance Verification - Hospital for Behavioral Medicine

Intensive Outpatient Program services is not a benefit with all insurance companies.

We work with insurance and you to provide the best possible coverage and minimize your out-of-pocket expenses. Fill out the form below and we will help you explore treatment costs and options.

"*" indicates required fields

Patient Information

Patient Name*

Patient DOB*

Your name (if different then patient's)

Phone*

Insurance Policy Holder Information

(The main person on the insurance policy)

Primary Insured Name*

Patient DOB*

Email*

Phone*

Insurance Information

Insurance Provider**

Insurance Phone

Insurance ID Number*

Insurance ID Number

Type of Plan

Additional Information

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HAVE YOU RE-ENROLLED IN MASSHEALTH (MEDICAID)?