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Health Plan Information and Assistance Request

168_receptionist

The Presbyterian Customer Service Center is here to help you with any inquiries or issues you may have. Please complete the following so that a representative can assist you.

Health Plan Benefits Information Request

Member's First Name*
Last Name*
Address*
City*
State*
Zip*
Contact Name *
Contact Phone
Email Address*
Presbyterian Member # or SSN*
Type of assistance needed*Benefits
Claims
Other
Please contact me
Suggestion/Comment
Presbyterian Claim Number
Presbyterian Date of Service*
Billed Amount
Type of Benefit* (i.e. Pharmacy, Hospital)

Questions or comments:

Attach Supporting Documentation:

File 1:
File 2:
File 3: