Health Insurance Claim Form Printable
Pictures. Please state as fully and accurately as possible the information asked for below and to return this form immediately to great eastern general insurance limited (company) with original final bills/receipts. The acceptance of this form is not in itself an admission of liability on.
This will delay the processing of the claim. There are two ways to submit your health insurance claim. Complete the patient/claimant section and have your physician complete the physician statement.
Please complete page 1 of this form in block capitals and ask your treating doctor/therapist to complete page 2.
All appropriate information must be provided to make the process faster. Any person who knowingly and with intent to deliaud any insurance company or other person files a statement of claim containing any materially false. The way to obtain benefits or payment is by submitting a claim via a specific form or request. Cms 1500 is a claim form for health insurance.