Insurance Verification

Crossroads can perform a free insurance verification, just fill out this form.

Step 1 of 3

33%

Patient Information
Name*
First Last
Patient Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Patient Phone*
Patient Email*
Patient Last Four SSN*
Patient Date of Birth*

Primary Insured Information
Primary Insured Full Name*
First Last
Primary Insured DOB*
Primary Insured Last Four SSN*
Primary Insured Phone Number*
Primary Insured Email Address*

INSURANCE COMPANY INFORMATION
Insurance Provider Name*
Insurance ID Number*
Insurance Group Number*
Insurance Company Phone #*
Insurance Type*
Captcha

The ‘No Surprise Act’ has gone into effect as of January 1st, 2022. It prevents out-of-network care providers from billing clients more than the specified in-network cost-sharing amounts, which are based on a ‘recognized amount’ (specified by state law, or for those that have an all-payer model agreement, approved by the state). You can learn more about the law at cms.gov/nosurprises.

Leave Comment

Crossroads can perform a free insurance verification, just fill out this form.

Step 1 of 3

Patient Information

Primary Insured Information

INSURANCE COMPANY INFORMATION

Cancel reply

Contact Crossroads

Find Help Today!

For Yourself
For A Loved One
Verify Insurance
More Information

Get Directions

To Egg Harbor

To Washington

Insurance Verification

Crossroads can perform a free insurance verification, just fill out this form.

Step 1 of 3

Patient Information

Primary Insured Information

INSURANCE COMPANY INFORMATION

Cancel reply

Contact Crossroads

Find Help Today!

For Yourself For A Loved One Verify Insurance More Information

Get Directions

To Egg Harbor

To Washington

For Yourself
For A Loved One
Verify Insurance
More Information