Insurance Coverage - Live Form

Fill Out The Form Below to Verify If Your Benefits Will Pay for Treatment

What you need to get started:
Health Insurance Card

Our team of specialists will do the necessary research to run a no-cost, private approval of your specific policy. If you have coverage of any kind from a major insurance provider, your treatment is likely covered. We promise to keep your information confidential.

Step 1 - Fill out all of the fields on the confidential form

Step 2 - A member of our staff will contact your insurer to verify if your policy will cover your treatment

Step 3 - We will contact you within an hour with the results of the verification and discuss next steps

If you are not the primary policyholder please fill out the additional fields below

*Insurance Disclaimer: Brookside Treatment will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” Brookside Treatment will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.