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  • Regence Sure Pay Form

Get Regence Sure Pay Form

Surepay Authorization Medicare Script TM Basic (PDP) Medicare Script TM Enhanced (PDP) PO Box 12625 Salem OR 97309-0625 Remember! No need to pay now. An invoice will be mailed to you first. FORM 4416MS.

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How to fill out the Regence Sure Pay Form online

Filling out the Regence Sure Pay Form online is a straightforward process that allows you to set up automatic deductions for your insurance premiums. This guide will walk you through each section of the form to ensure a smooth completion.

Follow the steps to fill out the Regence Sure Pay Form

  1. Press the ‘Get Form’ button to access the Regence Sure Pay Form and open it for editing.
  2. Begin by entering your name in the 'Name of Applicant' field. Ensure it is spelled correctly.
  3. Next, provide your Medicare number in the designated field titled 'Medicare Number of Applicant.' This information is important for processing.
  4. In the section that follows, authorize Regence BlueShield to charge your bank account by selecting the type of account (checking, savings, or money market) and providing the name of your bank.
  5. Record the date in the specified format (mm/dd/yyyy) to indicate when you are signing the form.
  6. To validate your account authorization, tape a preprinted check with 'VOID' written across it to this form. Do not include deposit slips.
  7. Review your entries carefully to ensure all information is accurate, as this will help prevent processing delays.
  8. Once you've completed the form, save your changes, and you can choose to download, print, or share the document as needed.

Complete your Regence Sure Pay Form online today for a hassle-free premium payment experience.

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Regence may provide coverage for Ozempic, a medication used for diabetes management. However, coverage can depend on your specific plan and coverage details. It is a good idea to check your policy documents or reach out to Regence customer service for the most accurate information. This way, you can ensure you have the necessary medications without unnecessary stress.

Health insurance providers typically offer various payment methods to accommodate their members. You can often pay through bank transfers, credit or debit cards, and even check payments. Many companies, including Regence, provide options for automatic recurring payments, which can be easily set up using the Regence Sure Pay Form. This flexibility helps you manage your health insurance payments effectively.

If you do not pay your Blue Cross Blue Shield bill, you may face several consequences. First, your coverage could become inactive, leaving you without access to essential health services. Additionally, unpaid bills can result in collection actions or impact your credit score. To avoid these issues, consider using the Regence Sure Pay Form to streamline your payment process.

To reach RGA customer service, you can call their dedicated support line at 1-844-REGENCE (1-844-734-3623). They are available to assist with inquiries related to your Regence coverage, billing questions, and the Regence Sure Pay Form. Having this information on hand allows you to get the help you need quickly and efficiently.

Regence offers various payment options to make managing your healthcare expenses convenient. You can pay online through the Regence portal, set up automatic payments, or choose to pay by mail. Moreover, when utilizing the Regence Sure Pay Form, you can ensure that payments are processed efficiently and securely. Exploring these options can help you find the method that works best for your financial situation.

While Blue Cross, Blue Shield, and Regence are often associated, they are not the same entity. Regence operates under the Blue Cross Blue Shield Association and offers specific plans in several states. It's essential to know that your coverage details and options, including the Regence Sure Pay Form, may vary depending on which organization provides your health plan. Understanding this distinction ensures you receive accurate services and support.

To check your Regence benefits, you can log into your online account through the Regence website. Simply enter your credentials and navigate to the benefits section. Here, you can access your coverage details, deductible status, and additional information about the Regence Sure Pay Form. This process is straightforward and allows you to stay informed about your healthcare benefits.

The timely filing limit for Regence claims is typically set at 180 days from the date of the service rendered. This guideline ensures that you submit your claims within an appropriate timeframe for processing. Utilizing the Regence Sure Pay Form can facilitate this effort, making your claim submissions straightforward and efficient. Staying on top of your filing limits helps prevent costly denials or delays in payment.

When filing a claim with BCBS, you usually have up to 180 days following the service date to submit your documentation. However, it’s essential to check your specific plan for any variations. To support this filing process, the Regence Sure Pay Form is a valuable resource that can assist you in adhering to this timeframe. Properly using this form can mitigate errors and enhance your chances of swift reimbursement.

For Blue Cross Blue Shield (BCBS) claims, you generally have 180 days from the date of service to file your claim. This duration may vary in some cases based on specific circumstances or plans. To simplify this process, consider using the Regence Sure Pay Form, which can aid in your submission efforts. Being aware of your claim timeline is vital to ensure your services are reimbursed without unnecessary delays.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232