Claim Issue? | Allen Assoc Website

Please Check One: Required

Policyholder

Dependent

Please Check All That Apply Required

Claims Payment Question

Enrollment or Eligibility Issue

Service Issue With the Insurance Company

Request for Copies of Forms

Problem With a Paid Claim/Disputed Benefit Payment

Question About Coverage for a Specific Service or Procedure

Request for General Employee Benefit Plan Information

Have You Contacted the Insurance Company Regarding This Issue? Required

Yes

No

If Yes, Were They Able to Help You to Your Satisfaction?

Yes

No

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