Insurance Verification

Prefer to verify your insurance over the phone?

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Imagine Lincoln works with most insurance providers in the U.S. to ensure the best possible coverage and minimize your out-of-pocket expenses. Fill out the form below, and we will help you explore treatment options and costs. Rest assured, your personal information is always safe and securely encrypted. Have your insurance card ready to verify it online or over the phone. Feel free to call us with any questions.

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Patient Information

(The person in need of treatment)

Patient Name*

First Name Last Name

Patient Date of Birth*

Contact Information

Contact Name

First Name Last Name

Phone*

Relationship

Message

How did you hear about Northpoint?

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Insurance Policy Holder Information

(The main person on the insurance policy)

Primary Insurer's Name*

First Name Last Name

Primary Insurer's Date of Birth*

Insurance Information

Insurance Provider*

Insurance Phone*

Insurance ID Number*

Insurance Group Number*

Request a call back!

Prefer us to call you to complete the insurance verification?

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Prefer to verify your insurance over the phone?

Patient Information

Contact Information

Insurance Policy Holder Information

Insurance Information

Request a call back!

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Imagine Lincoln

402.256.7425

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Imagine By Northpoint

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