Home > Blog

Midwest Recovery Centers Blog

Your Addiction Hurts Everyone

Not only does it rob the addict of their physical, emotional and psychological well-being, the effects of drug abuse on the family unit can be equally destructive and devastating.

Staffed 24 hours a day, 7 days a week.

Click or Call Today! 844-597-1376

Verify Your Insurance Coverage

General Information
Who Is This For?*
Patient Full Name*
Patient Date of Birth*
Patient Social Security #
Subscriber Full Name
Subscriber Date of Birth
Subscriber Social Security #
Email*
Home/Cell Phone Number*
How did you hear about us?*
Address
Address on file with your insurance carrier.
Street Address*
City*
State*
Zipcode*
Insurance Information
Insurance Carrier*
Insurance ID #
Provider Services Phone # (on back of card)*
Group ID #
Type of Plan
- PPO
- HMO
- EPO
- POS
- Unknown
Is this a COBRA Policy?
- Yes
- No
- Unknown
Photo Upload: FRONT of Insurance Card (optional)
Accepted file types: jpg, gif, png, pdf.
Photo Upload: BACK of Insurance Card (optional)
Additional Information
Have You Been to Treatment Before?
Brief Description of Your Problem
Comments
When and how is the best way to contact you?
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Midwest Recovery Centers Blog

Your Addiction Hurts Everyone

Start Your Recovery Now!

Follow Our Blog

Staffed 24 hours a day, 7 days a week.

General Information

Address

Insurance Information

Additional Information

Pin It on Pinterest