Insurance Verification

Treatment Covered by Insurance

At Rising Roads Recovery, we’re your top advocates and here to help sort through health insurance obstacles like securing treatment authorization and optimizing available coverage and necessary documentation. We’ll do our best to help you get the financial assistance you need.

PLEASE NOTE: Most insurance companies are now requiring you to call them to give permission for us to call them to check out-of-network benefits. This is required for OPTUM insurance customers. We recommend the following verbiage: “I’m calling to give consent for Rising Roads Recovery to obtain out-of-network benefits on my behalf. I’m also calling to ask if my claims pay based off a percentile of Fair Health – if so, what is that percentile?” We also recommend you write down the representative’s name and reference number.

Name of Participant(Required)

Participant Date of Birth*(Required)

Participant Address(Required)

Participant City(Required)

Participant State(Required)

Participant Zip(Required)

Participant Contact Number(Required)

Primary Policy Holder(Required)

Primary Policy Holder DOB(Required)

Primary Policy Holder's Street Address(Required)

Primary Policy Holder's City(Required)

Primary Policy Holder's State(Required)

Primary Policy Holder's Zip(Required)

Primary Policy Holder's Contact Number(Required)

Primary Policy Holder's Email(Required)

Insurance Company(Required)

Insurance ID(Required)

Insurance Provider's Number(Required)

Group Number(Required)

Rx BIN Number(Required)

Rx PCN(Required)

Rx Group(Required)

Type of plan(Required)

What is 9-3?(Required)

Security question, please answer the math question

How did you hear about us?(Required)

Treatment Covered by Insurance

Insurance Verification

Contact Information

Resources

Forms