How do you plan to pay?
To help us verify your benefits, please enter your member ID, the name of your insurance company, and the name and date of birth of the person who carries the policy (the primary insured—this may be you, a spouse, or a parent). This information ensures we can confirm eligibility before scheduling.
Limited to 600 characters
Upload a photo of your insurance card
If you are not using EAP services, please select “Not using EAP benefits” or leave this blank.
Enter the case number or authorization number you were given by your EAP. If we need your authorization letter for verification, we’ll send you a secure message through your client portal. If you are not using EAP services, please leave this blank.
If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.