Verify My Insurance

Foundry Front Range is a high-quality residential treatment provider that is in-network with Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and proudly accepts BHASO Regions 1, 2 & 3 Medicaid.

Please use this HIPAA-compliant secure form to provide your insurance information. We will verify your insurance benefits and discuss any anticipated out-of-pocket costs.

Patient Information

Please fill out the form completely. All fields are required.
First Name*
Last Name*
Patient's Date of Birth*

MonthDayYear
Date
Your relationship to the patient*
If other, please specify
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Primary Insurance Holder
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Insurance Company Information
Insurance Company*
Policy ID Number*
Policy Group Number*
Phone Number*
Please enter a valid phone number.
How did you hear about us?
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Verify My Insurance

Patient Information

Primary Insurance Holder

Insurance Company Information

You Are on The Right Track.