Insurance Verification Form

All Private PPO Medical Insurance Accepted. In Network (HMO) with Blue Cross Blue Shield and MultiPlan!

Use this form to quickly and easily verify your private or company provided health insurance plan benefits for addiction treatment services.

"*" indicates required fields

Patient Name*
Patient Date of Birth

We accept all private PPO health insurance plans nationwide for a variety of clinical services, such as Medical Detoxification, Residential/Inpatient Treatment (RTC & PHP), Outpatient Drug Rehab services (IOP & OP), private therapy & counseling, onsite drug and alcohol testing & reporting services, and more.

Upon successful submission on this form it will be sent directly and securely to our insurance VOB team.

***UNITED HEALTHCARE POLICY HOLDERS***
If your insurance carrier is United Healthcare, they have changed their policies on how healthcare providers can obtain a Verification of Benefits. As the policy holder, you MUST call the number on the back of your card and give verbal authorization to allow United Healthcare to release benefit information to Scottsdale Recovery Center. Once this has been completed, we will be able to obtain the necessary benefit information for your policy, in order to see what kind of coverage you have for our program. Please note the reference number and submit it below.

PLEASE make sure this is completed prior to submitting the form on this page in order to expedite the process, and allow us to serve you in the most timely manner possible.

Thank you!