LiveWell Wellness Centers - Wellness Center In Belleville, IL, USA

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Insurance Verification

Please provide the information requested below in order for us to accurately verify insurance coverage for your care. Please note that insurance may not cover services considered to be preventative or wellness in nature.

Date *

First Name *

Last Name *

Date of Birth *

Spouse Name

Spouse Date of Birth

Email Address *

Telephone Number *

Type of Coverage

....

Health InsuranceAuto AccidentPersonal InjuryWork Injury

Insurance Company *

Primary Insured

Primary's Date of Birth

I.D. # *

Group #

Ins Co Phone # *

Claims Mailing Address

Contact Person

Claim # (if applicable)

Attorney (if applicable)

Comments

Enter the verification code in the box below.

Verification Code: *

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LiveWell Hours

Mon	9am to 7pm
Tue	9am to 7pm
Wed	9am to 7pm
Thu	9am to 7pm
Fri	9am to 7pm
Sat	8am to 4pm
Sun	12pm to 5pm

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618-236-3600 Request
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LiveWell Wellness Centers
3030 Frank Scott Parkway West
Belleville, IL 62223
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Phone: 618-236-3600
Fax: 618-233-6100
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