Prospective Patient Form

Your Information

Person Completing This Form
Name
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By entering in your telephone number, you agree to receive transactional SMS notifications and reminders from ERC and Pathlight via short code 73821. Message and data rates may apply. Message frequency may vary. You may receive alerts until you choose to opt out of this service by texting STOP to 73821 or replying STOP to any of our messages. Text HELP to 73821 for assistance.
Mailing Address

Patient Information

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Treatment Information

Condition

Insurance Information

Please be advised that treatment coverage under Medicaid requires a Single Case Agreement (SCA). This is a special contract negotiated between ERC Pathlight and Medicaid for your specific treatment. While ERC Pathlight initiates this process on behalf of the patient, approval is determined by Medicaid.

We are in the process of increasing our ability to accept Medicaid, Managed Medicaid, Medicare, Medicare Advantage, VA or Tricare) plans.
At this time we are able to accept the following plans:

  • Patients with Medicaid seeking care in California, Colorado or Washington
  • Patients with Tricare West seeking care in Colorado, California or Washington

If you have these plans, please call us at 303-825-8595 to discuss the admissions process, or select the appropriate option from the list above. If you do not meet these exceptions, please contact your insurance company for assistance with seeking care at an in-network facility. Explore additional treatment options and resources that may be right for you on our insurance page.

If you are not currently insured, please learn about additional treatment options and resources that you may be eligible for here rather than submitting this form, or call us at 866-360-7449.

Insurer
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Current Treatment Team Information

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Eating Recovery Center is accredited through the Joint Commission. This organization seeks to enhance the lives of the persons served in healthcare settings through a consultative accreditation process emphasizing quality, value and optimal outcomes of services.

Organizations that earn the Gold Seal of Approval™ have met or exceeded The Joint Commission’s rigorous performance standards to obtain this distinctive and internationally recognized accreditation. Learn more about this accreditation here.

Joint Commission Seal