Insurance Questions for Drug & Alcohol Rehab — Houston Discovery Community

Payments & Insurance Verification

Insurance Verification Form

Client Name

First Name

Last Name

Email

Client Phone Number

Client Date of Birth

Subscriber Name

First Name

Last Name

Subscriber Date of Birth

Subscriber Social Security Number (last 4)

Insurance Provider

Name of insurance provider

Insurance Policy #

Insurance Group #

Insurance Provider Phone #

Additional Notes

Make Payment

Paypal

Insurance accepted, including but not limited to:

Aetna (Out-of-Network) Insurance
Affordable Private Pay Options
Aetna Medicaid
Traditional Medicaid
Amerigroup
Molina
Community Health Choice (Private Insurance)
Community Health Choice (Medicaid)
Cooks Children's Health Plan,
Parkland Community Health Plan
Sendero Health Plan (All are Under Beacon health Options)
The Harris Center IDD( formerly MHMRA Co-Occurring)