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VOLUNTARY HOSPITALS HOUSE STAFF BENEFITS PLAN 1027 46th Avenue, Suite 3002 Long Island City, NY 11101 How To File An OutofNetwork Claim A. Fill out the Member/Employee information and Patient Information

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Addendum No. 3 is a supplementary document that provides additional information or updates to a previously submitted form or application.

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The purpose of Addendum No. 3 is to ensure that all necessary updates, corrections, or additional data are properly documented and submitted for compliance purposes.

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The information that must be reported includes any changes or additional data related to the original submission that may affect its accuracy or compliance.

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