Clear Springs Ranch

Insurance Verification

Drug and alcohol rehab facilities usually accept most insurance which can cover the cost of treatment so you have little or no out of pocket fees. Fill out the form below and we will find out if your insurance will cover treatment. Don’t delay, the sooner you or a loved one gets treatment the sooner you can start the healing process.

Required *

Patient Name (required)

Patient Date of Birth (required)

Primary Insured Name (required)

Primary Insured Date of Birth (required)

Your email (required)

Last 4 digits of SSN (required)

Address (required)

City (required)

State (required)

Zipcode(required)

Phone number(required)

Insurance Provider(required)

Insurance Provider Phone(required)

Insurance ID number(required)

Group ID number(required)

Type of Plan

Comments

Verification *