Instructions For UHC Carriers

Follow These 3 Easy Steps

Either the subscriber or the dependent can make this call to United Healthcare.

“I am giving permission for Peaks Recovery Centers to verify out of network benefits for __________ (name of the person in need of treatment).

Make sure to take note of these two things, therefore you can easily enter this information into the form below..

Please fill out the form below, adding in the information you just collected from phone call with United.

Form to verify United Health Care Insurance

Contact Information
Who should we contact after verification?
Name*
First Last
Phone*
Email*
Insurance Information
Insurance Representative's Name*
Reference #*
Primary's Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Patient's Name*
First Last
Primary Date Of Birth*
Patient Date Of Birth*
Insurance Provider*
Member ID*
Group ID Number*
Insurance Phone Number
Comments
Front Of Insurance Card*
Back Of Insurance Card*
By submitting this form, I agree to be contacted by Peaks Recovery Centers. Our admissions director will contact you shortly to discuss your recovery options. All information shared with us is completely confidential. See our HIPAA Privacy Policy.