Insurance Benefits Verification

Beit T’ Shuvah accepts most PPO insurance plans and Medi-Cal. If you would like us to verify your coverage, eligibility, and benefits information for behavioral and mental health treatment services please fill out the form below.

Once complete, an admissions counselor will contact you with an explanation of the benefits available on your specific insurance plan. Insurance benefits can only be verified Monday through Friday during normal business hours. If you provide your insurance information after 5PM (PST) you will be contacted the following day.

Please note that we do not work with the following health care insurance plans: HMO’s, EPO’s, Medicare, and Medicaid.

Insurance Verification Form

Insurance Company*
Insurance Type*
Insurance Phone*
Client Name*
First Last
As listed on insurance
Client Date of Birth*
MM slash DD slash YYYY
Client SSN
Insurance Member ID#*
Insurance Group #
Issue/Effective Date*
Month
Day
Year
Address on file in insurance company
Street Address Address Line 2 City State ZIP Code
Front of Insurance Card*
Max. file size: 50 MB.
Back of Insurance Card*
Max. file size: 50 MB.
Front of Driver's License of ID*
Max. file size: 50 MB.
Prior treatment
- Short term residential
- Out patient
- Detox
Contact name*
First Last
Contact phone
Contact email*

Connect With Us

Insurance Verification Form

Donations
Matter

Connect With Us

Insurance Benefits Verification

Insurance Verification Form

Donations Matter

Donations
Matter