Insurance Verification Form
We know that contacting your insurance company to gain an understanding of your benefits is time-consuming and often frustrating. We would be happy to courtesy-verify your benefits so you clearly understand your coverage before starting treatment.
Complete the form below, and we will be in touch with you ASAP to inform you of your coverage and financial responsibilities.
[[[["field23","contains","John P. Carnesecchi, LCSW, CEAP"]],[["email_to",null,"john@gatewaytosolutions.org"],["email_to",null,"gtSverify@gmail.com"]],"or"],[[["field23","contains","John A. Mendiola, MD (Infusions ONLY, not therapy)"]],[["email_to",null,"jamendiolamd@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[[]],[],"and"],[[["field23","contains","Doria Miller, LMSW"]],[["email_to",null,"doriacmiller@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Madeline Weinfeld"]],[["email_to",null,"madelineweinfeld@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Mariam Hager, LMSW"]],[["email_to",null,"mariamhager@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Christine Menna, LMSW"]],[["email_to",null,"christinemenna11@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Caroline Grace Brown, LMSW"]],[["email_to",null,"carolinegbrown26@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Antoinette Bonafede, LMSW"]],[["email_to",null,"antoinette.bonafede27@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field44","equal_to","I am an existing client"]],[["show_fields","field46"]],"and"],[[["field53","contains","Yes, I have a secondary insurance policy"]],[["show_fields","field48,field49,field50,field51,field52,field54"]],"and"],[[["field23","equal_to","Not Listed"]],[["email_to",null,"nyfn17@gmail.com"]],"and"],[[["field23","contains","Christina Bradley, MS. Ed."]],[["email_to",null,"christinabradley.gts@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Danielle Dellaquila, LMSW, DBT"]],[["email_to",null,"DanielleDellaquila.gts@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Jamie Downie"]],[["email_to",null,"JamieDownie.gts@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Debra"]],[["email_to",null,"gtSverify@gmail.com"]],"and"],[[["field23","contains","Mandolin"]],[["email_to",null,"gtSverify@gmail.com"],["email_to",null,"Mandolinmoody.contact@gmail.com"]],"and"],[[["field23","contains","Valerie"]],[["email_to",null,"Valeriekowalski17@gmail.com"],["email_to",null,"gtSverify@gmail.com"]],"and"]]
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