Submit a VOB
Client Name
Date of Birth
Client Address
Insurance Name
ID #
Insurance Phone Number
Subscriber Name and Relationship
Referred By (Treatment Center)
Copy of Insurance Card (if available)
Email
Submit
Out of Network Insurance Accepted
for these levels of care
Verification of Benefits
Instructions:
Email VOB to
verification@mindfuli.com
Include the following:
Client Name
DOB
Client Address
Insurance Name
ID #
Insurance Phone Number
Subscriber Name and Relationship
Referred By (Treatment Center)
Copy of the Insurance Card
if available
Submit Form
Email VOB
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