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Submit a medical report

Please note

Sometimes we'll ask you for a medical report so we can decide about a member's claim. We'll usually tell you where to send this information, so please follow those instructions to help us deal with your query quickly.

If you're not sure where to send a medical report, complete the form below.

Provider name

Email address

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Patient's name

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Month

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Who is providing this report?

Please give details about the individual providing the report

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Acceptable file formats include: PDF, JPG, PNG, XLS, XLSX, DOC and DOCX
Maximum file size must not exceed 5MB

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