Check Your
Insurance Coverage

Let Us Help You

Please note: We are an out-of-network provider. However, we can check your out-of-network benefits to see what may be covered by your plan. If you do not have out-of-network coverage, please visit our Pricing & Packages page.

Fill out the short form below and upload a photo of your insurance card. We’ll review your information and follow up shortly to discuss what your plan may cover.

Step 1/3

Personal Information

Please provide your basic information to get started.

First Name *

Please enter your first name

Last Name *

Please enter your last name

Date of Birth *

Please enter your date of birth

Phone Number *

Please enter your phone number

State / Region *

Please enter your state or region

Email *

Please enter a valid email

Gender Identity *

Please select a gender identity

Step 2/3

Your Provider

Tell us a little more about your care preferences.

Provider *

Please select a provider

What lead you to ESSE Care? *

Please select an option

What Physician Referred You? *

Please enter the referring physician

What Patient Referred You? *

Please enter the referring patient

Step 3/3

Insurance & Message

Please upload your insurance card and share any details about your request.

Front: Insurance Card Image * Click to upload front of card JPG, PNG or PDF accepted

Please upload the front of your insurance card

Back: Insurance Card Image * Click to upload back of card JPG, PNG or PDF accepted

Please upload the back of your insurance card

Message *

0 / 250 words

Please enter a message

Form Submitted Successfully

We'll be in touch with you shortly.

Don’t Give Up
We’re Here to Fight for You

We know it’s hard. You may have already seen multiple doctors and still have no answers. But please don’t give up. We are here to advocate for you—with your insurance, your care plan, and your long-term healing.

Call us. Tell us what’s going on. Let’s figure this out together.