Most recent complete Federal 1040 Tax Form for family/individual (for clients age 3 and up only)
Treatment plan from Behavioral Health Treatment provider.
Information on the frequency of treatment (e.g. 5 days per week). Usually part of the treatment plan.
Summary of Benefits for your health insurance that includes information on the plan year, copayments or coinsurance amounts, and out of pocket maximums for the individual.
For plans with deductibles and coinsurance: copy of the billing statements/explanation of benefits from the health plan that indicate the deductible and /or copayments/coinsurance that is charged for Behavioral Health Treatment services