Insurance Application

Insurance Application

Trinity Teen Solutions is In-Network with many commercial insurance companies. Just to name a few we are happy to work with Blue Cross Blue Shield, Aetna, CIGNA, Tricare West, First Health, First Choice Health, UMR, GEHA, Health Partners, and a variety of other insurance companies. Unfortunately we do not accept Medicaid.

To get started Trinity Teen Solutions must submit your insurance information to our insurance billing department for a verification of benefits. Once the insurance information is received we can immediately begin the verification process on your behalf. The insurance billing department will get in contact with your insurance provider and get a detailed explanation of the mental health and chemical dependency benefits within your policy. This verification of benefits is made available for you generally within the same business day by one of our admissions counselors. Once we have this information we can tell you what your out of pocket expense will be.

The following pieces of information will be obtained:

  • Individual In-Network Out of Network Deductible depending on if we are In-Network or Out-of-Network with your insurance company, and what has been applied to date
  • Individual In-Network or Out of Network Out of Pocket Maximum depending on if we are In-Network or Out-of-Network with your insurance company, andand what has been applied to date
  • If your insurance charges any Co-pays and the amount that would be owed
  • Whether there are Annual or lifetime benefits
  • Co-Insurance % after deductible is met
  • Coverages available (RTC, PHP, IOP, GOP)
  • Whether there is a waiting period for pre-existing conditions
  • Call 307-202-8400 with any questions

    Parent Information:

    Phone Number:

    Email

    First Name

    Last Name

    Street Address

    City

    State

    Zip

    Child Information:

    First Name

    Last Name

    Date of Birth

    Age

    Street Address

    City

    State

    Zip

    Policy Holder Information:

    Name

    Relationship

    Phone Number

    Date of Birth

    Employer Sponsored Plan

    yesno

    State Employer Sponsored Plan is in

    Employer

    Insurance Company

    Insurance Company Phone

    ID#

    Group ID#

    Group Name

    Notes

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