Doctors HealthCare Plans, Inc. Your Health, Our Commitment
 2020 Ponce de Leon Blvd, Suite PH 1, Coral Gables, FL 33134   
  

Additional Claim Information Form

Please complete all necessary fields in the form. Supporting documentation must include the Copy of Records Request Letter and Medical Records. Submissions with incomplete information will not be processed.

CLAIM INFORMATION

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REQUIRED DOCUMENTATION

Click or drag a file to this area to upload.
The file formats you can upload are .tiff, .jpg, .png, .doc, and .pdf. If attachment is over 10MB, please split the file to conform to size limit.
Click or drag files to this area to upload. You can upload up to 3 files.
The file formats you can upload are .tiff, .jpg, .png, .doc, and .pdf. If attachment is over 10MB, please split the file to conform to size limit.

 Last Updated: 03/05/2021

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