Request a reimbursement
- Complete one form for each patient and incident.
- If you have another medical insurance policy, the application for reimbursement must first be processed by the other insurance company and then submitted to Bupa with an explanation of how the reimbursement was processed.
- If you want an ELECTRONIC REIMBURSEMENT, you must also complete the following form:
AUTHORIZATION FORM FOR ELECTRONIC
REIMBURSEMENT OF CLAIMS ( 164 Kb. )
FORM TO REQUEST A REIMBURSEMENT
( 32 Kb. )
to sign the form Use UPPER CASE LETTERSto complete all the sections of the form.
- Ask your
healthcare providerto sign and stamp the form Include all original invoiceswith the corresponding payment receipt
- Make sure we get a copy of the history of your illness or current condition
BY MAIL to:
17901 Old Cutler Road, Suite 400
Palmetto Bay, FL 33157
If you have any questions, contact us at +1 (305) 398 7400