Behavioral Health of the Palm Beaches

BHOPB is America's Premier Drug Alcohol Treatment Rehab Center, located in sunny South Florida

Insurance Verification Form

We are glad to verify any possible health insurance coverage of the prospective client. Please fill in the form below, accurately. A staff person will respond ASAP with your health insurance coverage.

(by filling out this form, you are authorizing us to check benefits)

Required*

person to contact *

contact person phone number*

contact person's e-mail address*

patient's full name*

patient's phone number

patient's full street address

address

city

state

zip code

patient's date of birth*

patients social security number
(123-45-6789)

name of the insurance company*

name of the primary insurance policy holder

( if different from the patient i.e. spouse or parent )

patient’s policy or subscriber ID*

insurance policyholders SSN
(if known)

insurance policyholders
date of birth (if known)

group number

customer service contact phone number

substance(s) being used

	alcohol		pills
	cocaine		meth
	crack		marijuana
	heroin		not sure

Other (explain)

comments

How did you hear about us?

BEHAVIORAL HEALTH VIDEO

Florida Drug Rehab Treatment Center Video

MORE BHOPB VIDEOS

	Spiritual Health		Family Week

QUICK LINKS

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Treatment Centers in Florida

BHOPB was recently featured on the T.V. series Intervention

call our 24/7 information center 1 800 251 9445