LAWSUITS NEWS & LEGAL INFORMATION

Out Of Network Medical (insurance overchages)

Please complete this claim form to request a free case evaluation from a lawyer listed on LawyersAndSettlements.com.

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Defendant:
(who caused the harm?)

*Describe your complaint:
(briefly describe the damages you have suffered)

Did you go to a doctor NOT covered by your health insurer's plan?

Yes No

Did you later learn that your insurance company did NOT fully reimburse your doctor?

Yes No

Did your doctor ask you to pay the difference?

Yes No

*First name:

*Last name:

*Email address:

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*Phone number(s):

*Zip/Postal Code:

Best time & way to contact you:

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