If you received a notice from us, our records show that you provided us with incorrect health insurance information or it may not have been properly submitted. Please use the button below to submit your insurance information.

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Please fill out the form in its entirety with your information that was active during the date of service referenced in the notice. 

The button above will open a secure submission form. If you prefer to provide your information in a different way or have questions regarding this request, please contact our Collections Department promptly.

 

 

We understand the importance of protecting your privacy and personal information. Our team adheres to all legal and regulatory requirements, including the Health Insurance Portability and Accountability Act (HIPAA), to ensure that your data remains secure. If you prefer not to use the link above, please contact our Collections Department by phone or email. We can work with you to collect the information in another way.

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