Verify Your Insurance

100% Secure & Confidential

At Windward Way, we accept most types of private insurance and offer a variety of payment options. Complete the form to privately check your insurance provider benefits for addiction treatment services. This means your treatment may be FREE¹ depending on your policy, copay, and deductible.

Have your insurance card ready.

General Information
Who Is This For?*
Patient Full Name*
Patient Date of Birth*
Patient Social Security #
Subscriber Full Name
Subscriber Date of Birth
Subscriber Social Security #
Email*
Home/Cell Phone Number*
How did you hear about us?*
Address
Address on file with your insurance carrier.
Street Address*
City*
State*
Zipcode*
Insurance Information
Insurance Carrier*
Insurance ID #
Provider Services Phone # (on back of card)*
Group ID #
Type of Plan
- PPO
- HMO
- EPO
- POS
- Unknown
Is this a COBRA Policy?
- Yes
- No
- Unknown
Photo Upload: FRONT of Insurance Card (optional)
Accepted file types: jpg, gif, png, pdf.
Photo Upload: BACK of Insurance Card (optional)
Additional Information
Have You Been to Treatment Before?
Brief Description of Your Problem
Comments
When and how is the best way to contact you?
Phone
This field is for validation purposes and should be left unchanged.

By submitting this form you agree to the terms of use and privacy policy of the website. An admissions counselor will contact you in a timely manner.

1 Insurance Disclaimer: Windward Way will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a verification of benefits and/or authorization. Your health insurance provider will be able to provide accurate and complete payment and verification eligibility. We cannot independently guarantee this information. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” Windward Way will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.

Verify Your Insurance

General Information

Address

Insurance Information

Additional Information