Insurance Verification Form
Christine Hurst, LCPC will do her best to verify your benefits prior to your first session. However, you are ultimately responsible for any balance not paid insurance. If you would like to contact your insurance company to better understand your benefits you will need to call the phone number on the back of your card for either Behavioral Health, Mental Health, or MH/SA. If these are not on the back of your card, please call the customer service number. Ask the representative for outpatient mental health benefits. Please be aware that the company that provides mental health coverage may be different than your individual insurance company.
Please fill out this form while on the call with the representative.