Get 8015675498

Filling out the 8015675498 form is essential for submitting health claims efficiently. This guide will provide you with a detailed, step-by-step approach to ensure you complete the form accurately and successfully.

Follow the steps to complete the 8015675498 form online

1. Click ‘Get Form’ button to access the form and open it in your editor.
2. In section A, enter your subscriber or Social Security number, along with your contact information including phone number, last name, first name, middle initial, home address, city, state, and zip code. If applicable, also fill in your spouse's details.
3. Move to section B to provide patient information. Indicate the patient's sex, relationship to the subscriber, whether they are a full-time student, and their date of birth. If there is a new address, check 'Yes' and provide the updated details.
4. In section C, describe any accident information, indicating whether it was a work or auto accident. Additionally, provide the date the accident occurred and any related details such as diagnosis and procedure codes from medical bills.
5. Proceed to section D regarding other insurance. If the patient has additional coverage, select 'Yes' and provide details about the other insurance policy, including the name of the insurance carrier, the person's name carrying that insurance, their Social Security number, and policy number.
6. In section E, sign and date the form if you want UnitedHealthcare to pay benefits directly to the medical service provider.
7. After completing all sections, save your changes. You can download, print, or share the filled form as needed. Remember to clip, do not staple all bills to the completed form before mailing them to UnitedHealthcare.

Complete your health claims by filling out the 8015675498 form online today.