Health REPORT A HEALTH INSURANCE CLAIM For greater efficienty, please have your provider file the claim directly to the insurance carrier. Know that we are available to advocate on your behalf, and please don’t hesitate to contact us.To contact us about a question, please complete the form below: Please enter the insured’s personal information so we can look up your policy and contact you regarding your claim. Name of Insured:(required) Mailing Address Line #1:(required) Mailing Address Line #2: City:(required) State:(required) Zip Code:(required) Policy Number: Company Name: Contact Name:(required) Contact Phone:(required) Contact Email:(required) How should we contact you? Email Phone Comments: Terms: This claim cannot be considered filed under the notification guidelines of your policy unless you receive a reply from our firm. If you haven’t received a reply within 48 hours, please contact us via phone.