Disputes

If you wish to dispute a debt, submit the form below and we’ll work with you to resolve your request. Please review all information for accuracy before submitting.

"*" indicates required fields

Name*

First Middle Last

Address*

Street Address City State ZIP Code

ARR Account Number*

Email*

Phone*

I want to dispute the debt because I think*

This is not my debt

The amount is wrong

My insurance covered this amount

Other

Insurance Provider Details*

Please provide the details of your insurance plan. If you have multiple plans, include them all by using the "+" button to add additional rows.

Primary Insured Full Name

Primary Insured Date of Birth

Insurance Provider

Insurance Claims Address

Insurance Phone #

Policy ID

Group ID

Comments

This field is for validation purposes and should be left unchanged.

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