Medical Insurance Payment Reimbursement Form

Occasionally, health insurance subscribers are unable to submit proof of coverage when paying a medical bill. The Medical Insurance Payment Reimbursement Form is the tool to request repayment for that cost. Most insurers offer a certain period of time for subscribers to submit this request for reimbursement. This form can be used for most any type of medical payment, such as prescription, emergency bill, office visit etc. but it can be tailored to fit your needs.