Member Support Request If your plan or membership offers you GetAdvocacy services, you may use this form to submit a bill for negotiation or help finding a provider. Type of RequestFind a ProviderBill NegotiationName(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Member/Subscriber IDBrief Description of your Bill(Required)Maximum 100 charactersType of Bill(Required)Emergency RoomUrgent CareHospital - OutpatientHospital - InpatientOtherComments(Required)Please provide us with any additional information you think we need regarding your medical billAttach related bills here(Required)You're allowed up to three (3) files no larger than 25MB each. Drop files here or Select files Max. file size: 25 MB, Max. files: 3. NameThis field is for validation purposes and should be left unchanged.
