Genesis

Insurance Coverage - Treatment

Genesis House accepts most major insurance policies. Please provide us with some brief information and we will contact you within one hour about your coverage for treatment. All information provided will be kept strictly confidential."

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 *
Name of the Insurance Company *
Name of the Primary Insurance Policy Holder (if different from the patient)
Patient’s Policy or Subscriber ID *
Insurance Policyholders SSN (if known)
Insurance Policyholders date of birth (if known)
Group Number
Customer Service Contact Phone #
Questions
Whom May We Thank for Referring You?
Please Enter Security Code Given on Right *

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Mike B.Before entering the Genesis House Center my life was falling apart but I was the last one to see it. I was drinking every night after work, fighting...