Request appointment | Therapy Health Clinic PLLC

Request an appointment

Medical Insurance Name/ Network (BCBSIL PPO, Aetna, Cigna, United, etc)

Provide the insurance name here as written in the insurance card including specific network PPO/HMO Medicare Advantage *if BCBSIL*

Limited to 600 characters

Insurance card upload

Upload a photo of your insurance card

IF USING MEDICAL INSURANCE: To expedite this coordination process, please provide your insurance Member ID number below if you intend to use medical insurance for your care. The clinic conducts pre-verification to determine copays, coinsurance, and network status. However, we strongly recommend contacting your insurance provider directly using the number on the back of your card to confirm your specific coverage for therapy services. This is particularly important if you wish to verify these details in advance or if the clinic is unable to complete the pre-verification process 48 hours prior to your session. Please be advised that you are solely responsible for client out-of-pocket costs such as copay, coinsurance in accordance with your insurance coverage, or the full cost of the service if the provider is out-of-network or if you have an unmet deductible on the day of your appointment. Understanding your specific insurance policy and coverage remains the client's responsibility.

Medical Insurance Member ID (Write EAP or N/A if not applicable or unavailable at the moment)

EAP BENEFITS PROVIDER: When utilizing an Employee Assistance Program (EAP), identify the specific EAP provider (e.g., ComPsych/ Guidance Resource, Curalinc, Optum, EverNorth, etc.) the issuer of the authorization/ EAP code. Note that the EAP source is distinct from the client's employer name or medical insurance; these are separate payer types that must be managed independently to ensure accurate claims processing.

(Compsych/Guidance Expert, Optum, Curalinc/ Amtrak, EverNorth, CCA, etc) Write Name of EAP network here otherwise indicate Not applicable (if using Insurance)::

IF USING EAP, Provide EAP Authorization/ Referral Code/ EAP Code

Answer "Insurance or N/A if EAP doesn't apply:

VERIFICATION: If unable to upload Insurance/ EAP details: Client can text/email the insurance Card photo of their insurance card (front & back picture) to Admin @ 708-888-0491/ email admin@therapyhealthclinic.com within 24h of this booking request.

If unsure/ unable to give agent the insurance or EAP referral code, client must follow-up/ contact the office by phone/ email within 24-48 hours after scheduling for Insurance/ EAP verification. Pls. text the EAP code and EAP network (If applicable). If using Medical Insurance: Upload the photo of the insurance card (front and back) via email to admin@therapyhealthclinic.com or TEXT 708-888-0491. Confirm if card was sent via text/email or uploaded into the client portal..

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.