Submit a Claim

We are here to help you! If you are having a problem with your insurance and need to submit a claim enter as much information as you can here and one of our staff members will contact you with the next step!

Name*
First Last
Phone*
Email
Date of Service
Facility Where Service Took Place
Doctor's Name
Cost of Service
Brief Description of Issue
Upload Bill - Optional
Max. file size: 50 MB.
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