11/05/2014 by DrCurry Check your surgical weight loss benefits! Insurance Verification For Surgical Weight Loss If you are unsure about your coverage for surgical weight loss, just complete and submit this form! X/TwitterThis field is for validation purposes and should be left unchanged.Your Name* First Last Your Email Enter Email Confirm Email Your Phone*Primary Insurance InfoPrimary Insurance Company*Primary Insurance Phone Number*Policy Holder's Name*Policy Holder's DOB*Policy Holder's Employer*Relationship To You (leave blank if it's you)*ID Number*Group Number*Secondary Insurance InfoDo you have a secondary insurance?* Yes No Secondary Insurance CompanySecondary Insurance Phone NumberPolicy Holder's NamePolicy Holder's DOB (leave blank if it's you)Policy Holder's EmployerRelationship To You (leave blank if it's you)ID NumberGroup NumberInsurance card (snap a pic of front and back) Drop files here or Select files Max. file size: 50 MB. Additional InfoConsent to Transmit* I give permission for this into to be transmitted via internet to JourneyLite Physicians.