Verify Your Insurance

Let’s verify your coverage for treatment at a Vogue Recovery Center location. Your information is always confidential.

Have your health insurance card ready

How to fill out our verification form

Identify Your Insurance Provider
We’ll be able to tell you if your provider is in-network.

Provide Contact Information
You will receive a call from us with treatment options.

Enter Your Policy Information
We’ll need information located on your insurance card.

Your Name*
First Last
Return Callback Phone Number*
Email*
Who is seeking treatment?
- Yourself
- A Loved One
Loved One's Information (Only Complete if You Are Seeking Treatment for A Loved One)
Loved One's Name
First Last
Loved One's Date Of Birth
MM slash DD slash YYYY
Your Date Of Birth
MM slash DD slash YYYY
Additional Information
Insurance Information
Would you like us to verify your insurance benefits? (or a loved one's insurance benefits?)
- Yes
- No
Policy Holders Name
First Last
Policy Holders Date Of Birth
MM slash DD slash YYYY
Policy Holders Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Insurance Company's Name
Insurance Company's Phone Number
Member ID
Group Number
Subscriber relationship to client