Verify Your Insurance Coverage

We Work with Most Major Insurance Carriers

Unsure how your insurance works? No worries. We’re experts at navigating the insurance world, so we make the process easy.

Simply fill out your information below, and we’ll determine your insurance coverage and how we can best utilize it to help pay for our treatment programs. And if you have any questions during the process, don’t hesitate to contact us. We’ll find answers for you.

Once you submit your information, our admissions team will get back with you ASAP.

Your Contact Information
Your Name*
First Last
Return Callback Phone Number*
Email*
Who is seeking treatment?*
- Yourself
- A Loved One
How Did You Hear About Us?
Loved Ones Information
Your Information
Loved Ones Name*
First Last
Loved Ones Date Of Birth*
MM slash DD slash YYYY
Your Date Of Birth*
MM slash DD slash YYYY
Additional Information
Insurance Information
Would you like us to verify your or a loved ones insurance benefits?*
- Yes
- No
Policy Holders Name*
First Last
Policy Holders Date Of Birth*
MM slash DD slash YYYY
Policy Holders Address**
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Insurance Company's Name*
Insurance Company's Phone Number*
Member ID*
Group Number*
Subscriber relationship to client*
Voice Confirmation*
By checking this box you are providing your expressed written consent and willingness for ILC to call you. We will never share your information.
- Yes
SMS confirmation*
By clicking this box you are providing expressed written consent to have ILC contact you via SMS messages 2-4/mo, or in varying amounts. We never share your information. Standard message and data rates apply. Text Opt-Out to be removed at any time.
- Yes

Verify Your Insurance Coverage

We Work with Most Major Insurance Carriers

Your Contact Information

Loved Ones Information

Your Information

Insurance Information

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