Claim Help Request
Most claims can be handled by your medical provider but on claims that require you to file directly with the company, please contact the company directly for assistance with your claim. Make sure to have the following ready before contacting the company you are filing a claim with.
- An itemized statement showing full name, address, and Tax ID of the provider
- Also, the statement must include the date of service, amount for each service, and diagnosis/procedure codes.
- ER or Outpatient Hospital visits must include 3-digit Revenue Codes.
- Copy of Explanation of Benefits must be supplied.
- Name and policy number must appear on all documents.
If you are still in need of claims assistance, please use the claim help request form below to notify us.
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.