Insurance Check Out

We’ll verify benefit and provide out-of-pocket cost before submitting a claim.

Signia Silk IX

Two small earbud hearing aids, one blue and one pink, with black ear inserts, floating against a white background with a light gray pattern.

Final cost - after your benefit is verified.

Instructions

Fill out form.
Send us photo of Insurance Card.
We’ll verify your benefit.
We’ll contact you to continue the benefit claim process.

Upload Insurance Card

Or text us a picture to 801-784-6900
Or email it to: info@purehearing.com

HIPPA Compliance

Your personal health information is safe and secure.

Model

Color

Ear

Name

First Name

Last Name

Phone

(###)

###

####

Email

Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Insurance Provider

Member ID

Date of birth

MM

DD

YYYY