Claim Help

Get Help with a Claim or Update Your Information on File with Us

Most likely you've arrived at this contact form from a button or link. The service type will be filled in from that link. If not, select the type of service you need, fill in the required fields and we'll get right back to you via EMail or phone.

For Claim assistance or updates to your information on file, please note the required fields indicated with asterisks (*)

Select Type Service:

A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator.

Here is a list of documents that will help us help you with your Claim or Policy Information Updates:

  • Policy Numbers
  • Initial Treatment Dates
  • Follow Up Visit Dates
  • Doctor’s Notes
  • Surgical Notes
  • Treatment Notes
  • UB-04 (Itemized Statement from Hospital)
  • HCFA 1500 (Itemized statement from Doctor’s Office)
  • Register of Visits from your Physical Therapist (Accident Insurance)
  • ADA Billing Form for Dental Claims (from your dentist/orthodontist office)
  • Birth Certificate
  • Death Certificate
  • Deed of Adoption
  • Notice of Loss of Credible Coverage
  • Marriage Certificate
  • Divorce Decree

You are always welcome to give us a call during business hours.  Tap or Click the Call Us button.