Skip to content
Call Us Today! 1-855-702-0218
|
info@westhollywoodatc.com
Search for:
Home
About
Virtual Tour
Detox Programs West Hollywood CA
Residential Drug Treatment Programs
Insurance Verification
Contact
Home
About
Virtual Tour
Detox Programs West Hollywood CA
Residential Drug Treatment Programs
Insurance Verification
Contact
Insurance Verification
jdudash@westhollywoodatc.com
2019-02-08T01:14:02+00:00
Insurance Verification
Need us to check your insurance? Simply fill out the secure form below and one of our representatives will check for you!
Please enable JavaScript in your browser to complete this form.
Patient's First and Last Name
*
First
Last
Patient's Date of Birth
Phone Number
Patient Email
Insurance Company
Member ID Number
Provider Contact Phone Number(found on back of insurance card)
Policy Holder's First and Last Name
Policy Holder's Date of Birth
Checkboxes
Alcohol Detox Program
Heroin Detox Program
Cocaine/Crack Cocaine Detox Program
Suboxone Detox Program
Prescription Pills Detox Program
Methamphetamine/Amphetamine Detox Program
Residential Treatment Program
Name
Submit
Page load link
Go to Top