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Insurance Submission Form

Many insurance companies provide coverage for most or all of treatment at Liberation Way. For the uninsured, we offer competitive self-pay rates to provide affordable treatment.

Navigating insurance can be difficult and time consuming. We Understand and  are here to walk you through the entire process.

Find out if your insurance will pay for your medically managed Detox.

Since we work with most insurance providers, you can fill out the form below, and we will be able to let you know if all or part of your care at Liberation Way will be covered by your insurance.

All information is completely confidential and protected by patient confidentiality laws.

Someone will call you with the verification of your coverage.

Insurance Verification Form

Your information will always be kept confidential.
All fields marked with an * indicate a required field.

Your Information

Patient Information

For which specific drug(s) or alcohol?

Subscriber Information

Insurance Information