Click here to download a PDF file of typical information requested by insurance companies.

The form provided here is offered as an example that you may find informative. This templates may be suitable for submission to your insurance provider, but double-check rather than assuming this is acceptable—even if the same information is provided in a similar format, non-company forms are not allowed by many insurance companies, and using them could result in an automatic rejection.

When in doubt, always use the official paperwork of your insurance company, and if there’s any question, contact a service representative. After all, it takes far less time and effort to make a phone call than to resubmit paperwork or start the whole process over again. For general help or questions specific to our program, you should also feel free to contact us at any time at 937-433-5957 or 1-866-395-5957.