Use Our Free Insurance Verification to get the Help You Deserve- ASAP Rehab

Insurance Verification

At ASAP, we accept most HMO and PPO insurance plans. We’re always happy to assist in verifying your coverage and eligibility for the treatment programs that we provide. After you fill out the form below and submit it to us, our admissions counselors will review the information you provided and get in touch with you to go over the services covered by your insurance plan. Please note that it could take up to 24 hours to process the information that you submit.

1 Personal Information

2 Policy Holder Information

3 Insurance Information

Are you filling out this for yourself or on behalf of someone?*
- For myself.
- On behalf of someone.
Your name*
First Last
Name of person seeking treatment*
First Last
Their date of birth*
Date Format: MM slash DD slash YYYY
Contact phone number*
Contact email*

Policy holder's name*
First Last
Relationship to person seeking treatment*
Policy holder's date of birth*
Date Format: MM slash DD slash YYYY
Policy holder's address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Insurance Information

Insurance Verification

We have expert addiction-specialists standing by ready to speak confidentially with you. Call us today!

Call Now! 833.827.ASAP (2727)