Pay Bill

During their stay, clients focus on their recovery 24 hours a day, in structured treatment sessions and through their daily living at our residence.

We accept:

Payments from counties and other social service agencies who refer clients
Insurance – DeanHealth, Group Health Cooperative of Southern Wisconsin, The Alliance, BadgerCare clients with Quartz HMO (single case agreements), Anthem

We do not accept personal checks.

Client Name*
Is this Payment for:*
- Insurance Deductible, Copayment or Coinsurance?
- Days of Treatment
- Private Pay
How Many Days of Treatment?
Payment Amount*
Credit Card Holder*
First Last
Credit Card Holder's Address*
Street Address Address Line 2 City State ZIP Code
Hidden
Country*
Credit Card*

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Credit Card Holder's Phone
Credit Card Holder's Email*
Enter Email Confirm Email
Special Message or Comment
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