Superbill Services
In most cases, we can help you get some of your money refunded from your health insurance provider after visits to cash-only clinics, or out-of-network providers. The amount returned is based solely on your insurance plan. We'll do the paperwork, you'll get the refund!

After submitting this form, one of our representatives will contact you to complete your enrollment. Please note we will require a front and back picture of your government issued ID.

Enrollment consists of a 30 minute phone call with you and your insurance provider to gather necessary information. There is a one-time $25 charge for this call. There is a charge of $2.50 plus shipping and handling for each superbill we submit on your behalf. By submitting this form, you agree to these charges.
Email address *
Name *
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Date of Birth *
Address *
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Phone number *
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Who is your Insurance provider? *
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Please enter your Member ID *
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Please enter your Group ID *
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By submitting this form, you agree to the charges outlined above. *
Please enter your initials to indicate a signature: *
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