Health Advocate | Medical Bill and Claim Resolution

About You

First Name Last Name Date of Birth

Is this claim/billing issue for you? Yes No

If no, then who is the claim issue for? First Name Last Name Relationship Please choose a relationship. Date of Birth Date of birth is not valid.

Have you already filled out a Health Advocate and HIPPA Release of Information Form and your Health Plan’s authorization forms, within the last 12 months? Yes No

Please be aware: all Release of Information Forms must be signed by the patient unless the patient is under 18 years old.

Claim Details

Select your Health Plan Type of bill Please choose a type of bill. Date of Service for Claim Date is not valid. Describe the issue: Please tell us about the issue.

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Learn More

Browse our library of resources on medical billing.

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