Enter your complete Patient Account Number as seen on your statement.

    Service Date 1

    and Service Date 2 (If Applicable)

    and  Service Date 3 (If Applicable)

This Bill Has Been Paid Please Charge my Credit Card My Insurance Has Paid The Bill Incorrect Insurance Incorrect Member Id     Quick Problem Reference List

Aetna Blue Care Network BCBS Champus Cigna Medicaid Medicare PPOM Teamsters Tricare Unicare United Health Care Other or not listed      Please Select Your Correct Primary Insurance Co.  If your insurance is not listed please select other and include the correct billing information in the text boxes below.

  Enter Your Member ID # Here

    Enter Your Group # Here

In the below box, please describe your billing question or problem as thoroughly as possible. If your insurance is not listed above, please provide it here. You will receive an email or a phone call when your inquiry is reviewed and resolved.  Please allow at least 24 hours for a response.