Dispute an Account or claim

If you would like to dispute an account please provide the following information so we can investigate.

File Number*

IF YOUR ACCOUNT IS A MEDICAL DEBT, WE HAVE PREVIOUSLY PROVIDED YOU WITH THE PROVIDER’S NAME, AMOUNT AND DATE OF SERVICE FOR THE BALANCE OWED. OUR CLIENT HAS BILLED YOUR INSURANCE AND THEY HAVE DEEMED IT THE PATIENT’S RESPONSIBILITY. TO EXPEDITE THE RESOLUTION OF THIS DEBT, PLEASE REFER TO THE BACK OF YOUR INSURANCE CARD AND THERE IS A MEMBER PORTAL WHERE YOU CAN PUT IN THE DATE OF SERVICE AND PROVIDER, AND IT WILL TELL YOU WHY THE DEBT IS OWED BY THE PATIENT VIA EXPLANATION OF BENEFITS (EOB). IF AFTER YOU HAVE REVIEWED YOUR EOB AND IT IS DETERMINED THAT THERE WAS AN ERROR IN BILLING OR THE AMOUNT OF PATIENT RESPONSIBILITY IS NOT CORRECT, PLEASE EMAIL US A COPY OF THE EOB AT CONTACT@CRCORP.NET AND WE WILL HANDLE IT ACCORDINGLY WITH OUR CLIENT. DUPLICATE REQUESTS FOR SUPPORTING DOCUMENTATION WILL NOT BE PROVIDED.
First Name*
Last Name*
Street Address*
Address Line 2
City*
State
Zip Code
Phone*
Amount Paid to Creditor*
Method of Payment
- Check
- Credit Card
- Money Order
- Cash
Date of Payment

mm/dd/yyyy
Check Number
Date of Check

mm/dd/yyyy
Date Check Cleared Bank

mm/dd/yyyy
Type of Credit Card
- Visa
- Mastercard
Last Four Digits on Credit Card

xxxx
File
Drop files here or

Accepted file types: jpg, png, pdf, jpeg, xps, Max. file size: 5 MB, Max. files: 3.
Terms & Conditions*
- I have read and accept the Terms & Conditions stated below.
Email
This field is for validation purposes and should be left unchanged.

Capital Recovery Corporation
P.O. Box 1008
Alpharetta, GA 30009
Phone: 800-456-8448
Fax: 770-216-9353
Email: contact@crcorp.net
To consent to text messaging: text CONTACT to 77476

TERMS & CONDITIONS:
By checking the “Accept Terms & Conditions” box above you are asserting that you are the named individual on this account and are authorized to review and discuss the personal information contained in the account. Furthermore, you are expressly authorizing Capital Recovery Corporation, representatives to contact you or responsible party, including but not limited to contact via prerecorded messages, artificial voice messages, text or electronic messages and calls made by an automatic telephone dialing system, at any phone number or any cellular phone, which could result in charges to you, or other wireless device including any cellular phone number you currently have or will have in the future and at any e-mail provided for the purpose of contact in connection with resolution of this account. You agree that both the cell phone number(s) and/or e-mail address you provide belong to you, are secure and cannot be listened to or viewed by unauthorized third parties.

ACCEPTANCE OF MINI MIRANDA AND DISCLOSURES:

BY SUBMITTING THIS FORM, YOU ACKNOWLEDGE THAT THIS COMMUNICATION IS FROM A DEBT COLLECTOR AND IS AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

We are required under state law to notify consumers of the following rights. This list does not contain a complete list of the rights consumers have under federal, state, or local law.

For State of California Consumers:
If the account listed is medical in nature the state requires us to inform you, “Nonprofit credit counseling services may be available in the area”.

The state Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act require that, except under unusual circumstances, collectors may not contact you before 8 a.m. or after 9 p.m. They may not harass you by using threats of violence or arrest or by using obscene language. Collectors may not use false or misleading statements or call you at work if they know or have reason to know that you may not receive personal calls at work. For the most part, collectors may not tell another person, other than your attorney or spouse, about your debt. Collectors may contact another person to confirm your location or enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission at 1-877-FTC-HELP or www.ftc.gov.

Capital Recovery Corporation does not sell your personal information. To change or delete your contact information, please log onto the Secure Online Portal at https://www.clientaccessweb.com/CRC/Payments/ and click on “My Account” and then “Update Account Information”.

For State of New York Consumers:
If a creditor or debt collector receives a money judgment against you in court, state and federal laws may prevent the following types of income from being taken to pay the debt: Supplemental security income, social security, public assistance, spousal support, maintenance (alimony) or child support, unemployment benefits, disability benefits, workers’ compensation benefits, public or private pensions, veterans’ benefits, federal student loans, federal student grants, and federal work study funds, and ninety percent of your wages or salary earned in the last sixty days.

Debt collectors are prohibited from engaging in abusive, deceptive, and unfair debt collection efforts, including but not limited to: The use or threat of violence, the use of obscene or profane language, and repeated phone calls made with the intent to annoy, abuse, or harass.

For City of New York Consumers:
New York City Department of Consumer Affairs License Number: 2057060-DCA. Capital Recovery Corporation conducts its business in English and does not provide any language access services or translations in any other language; The New York City Department of Consumer Affairs provides a translation and description of commonly used debt collection terms available in multiple languages on the Departments’ website, www.nyc.gov/dca

For State of Tennessee Consumers:
Capital Recovery Corporation is licensed by the Collection Service Board, State Department of Commerce and Insurance.