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Insurance Verification Form

Please fill out the form below, and we will be in touch with you shortly. Thank you.

Patient Name:*
First Last
Patient Phone Number:*
Point of Contact (who should we call back if NOT Patient Name above) :
Point of Contact Phone Number:
Patient Date Of Birth:*
Month
Day
Year
Email Address:*
Primary Insured Address:*
Street Address Address Line 2 City State ZIP Code
Primary Insured Name:*
Primary Insured Phone Number:*
Primary Insured Date Of Birth:*
Month
Day
Year
Insurance Company Name:*
Insurance Company Phone Number for Providers (Mental Health or Substance Abuse):*
ID #:*
Group #:*
Will the patient be getting FMLA Leave while in treatment?*

FMLA refers to the Family and Medical Leave Act, which is a federal law that guarantees certain employees up to 12 workweeks of unpaid leave each year with no threat of job loss. FMLA also requires that employers covered by the law maintain the health benefits for eligible workers just as if they were working.

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Twin Lakes Recovery Center

398 Highway 11, SW
Monroe, GA 30655
Fax: 770-266-3731

We Accept All Major Insurance

Twin Lakes Recovery Center accepts anthem blue cross insurance - substance abuse treatment in Georgia - Monroe Georgia drug addiction rehab and alcohol treatment center

Twin Lakes Recovery Center accepts Magellan Health Services insurance - partial hospitalization program - php and iop substance abuse treatment - Monroe Georgia drug addiction rehab and alcohol treatment center

Twin Lakes Recovery Center accepts Optum Insurance - outpatient addiction and substance abuse treatment

Humana Insurance