Get the free Regence Direct Member Reimbursement Form - LClark.edu

AB Displease return the completed form. By Mail: PO Box 1271 Portland, OR 972071271 By Fax: 1 (866) 3035117Regence Blue Cross Bluesier of Oregon 100 SW Market Street PO Box 1271 Portland, Oregon 972071271BAffidavit

How to fill out regence direct member reimbursement

How to fill out regence direct member reimbursement

1. To fill out Regence Direct Member Reimbursement form, follow these steps:
2. Download the Regence Direct Member Reimbursement form from the official Regence website.
3. Fill out your personal information, including your name, address, and contact details.
4. Provide your Regence insurance information, such as your member ID and group number.
5. Specify the date of service for which you are seeking reimbursement.
6. Attach all relevant supporting documents, such as medical bills, receipts, and explanation of benefits (EOB).
7. Indicate the total amount you are requesting for reimbursement.
8. Sign and date the form.
9. Submit the completed form along with the supporting documents to the designated Regence claims address.
10. Keep a copy of the form and documents for your records.

Who needs regence direct member reimbursement?

1. Regence Direct Member Reimbursement is needed by individuals who have Regence insurance and have paid for eligible healthcare services out-of-pocket.
2. These individuals may include policyholders, dependents, or other covered individuals who seek reimbursement for medical expenses not covered directly by Regence.
3. Those who want to be reimbursed for services received from non-network providers or for services that are not typically covered under their insurance plan can use Regence Direct Member Reimbursement.

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What is regence direct member reimbursement?

Regence direct member reimbursement is a process where members can submit claims for eligible medical expenses directly to Regence for reimbursement.

Who is required to file regence direct member reimbursement?

Regence members who have paid out-of-pocket for eligible medical expenses and wish to be reimbursed can file regence direct member reimbursement.

How to fill out regence direct member reimbursement?

To fill out regence direct member reimbursement, members need to complete a reimbursement form provided by Regence, attach any necessary supporting documentation, and submit the form either online or by mail.

What is the purpose of regence direct member reimbursement?

The purpose of regence direct member reimbursement is to provide members with a way to get reimbursed for eligible medical expenses that were paid out-of-pocket.

What information must be reported on regence direct member reimbursement?

The information that must be reported on regence direct member reimbursement includes the member's name, policy number, details of the medical expenses incurred, date of service, and proof of payment.