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Insurance Forms

At Alpine Recovery Lodge, we will work with your insurance provider to make this process easy for you and your family.

Payment Options for Recovery Treatment

If you don’t have insurance coverage – or if the coverage you do have doesn’t provide the benefits you need – you still have other options. One of our qualified team members will evaluate your need, insurance coverage, and financial situation.

Verifying your insurance is a simple three-step process:

Complete the fields below as accurately as possible.
Soon after you’ve completed your insurance forms, one of our admissions counselors will contact you to learn more about your circumstances so that we can identify the most appropriate strategy. Typically, we can confirm your coverage in a matter of hours.
When we verify your insurance coverage, we will initiate the intake process so that you can begin your journey to recovery.

Please fill out the insurance forms below to start the verification process.

Patient Name(Required)

First Last

Email(Required)

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Patient's Primary Phone(Required)

Date of Birth(Required)

Name of Policy Holder

Relationship to Patient

Policy Holder Employee

Policy Holder Date of Birth

Insurance Company Name

Insurance Phone Number

Policy ID Number

Group ID Number

Secondary Insurance Policy

Yes

No

Insurance Company Name #2

Insurance Phone Number #2

Policy ID Number #2

Group ID Number #2

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Our Facility

Alpine Recovery Lodge

1018 E. Oak Hill Drive
Alpine, Utah 84004

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