AfterHoursClaims.com :: Claim Inquiry

1. Claim Inquiry Form
All required fields on a screen must be completed before you will be allowed to continue.
Today's Date:		Date is automatically populated for you.
* Representative Name:		Type in your first and last name. The value entered here will be stored for 8 hours, but can be changed at any time.
* Caller First Name:		*May I have your name?*
* Caller Last Name:		*May I have your name?*
* Relationship to Cardholder:		If the caller has not identified themselves as the cardholder, ask: *What is your relationship to the cardholder?* Relationship can be CardHolder, Spouse, Child, Other. Choose CardHolder if the caller is actual cardholder. This will auto-populate the Cardholder first and last name fields
* Cardholder First Name:		*May I have the cardholder's name?* You will only have to ask this if the caller is someone other than the Cardholder.
* Cardholder Last Name:
* Home Phone:		*What is the cardholder's home telephone number, with area code?*
Contact Phone Number:		*During the weekday hours of 8 am to 8 pm (Eastern Time), is there a different phone number (besides Home #) that a claims specialist can use to contact you?* After the Phone # you can type in Work, Cell, Fax, etc.
E-mail Address:		*Do you have an email address that they may use to contact you?* Type NONE or UNKNOWN if applicable
Claim Number (if applicable/known):		*May I please have your claim Number?*
* Reason for Call:		Based on the information the caller gave at the beginning of the call, you should be able to ask a specific question for the Reason of Call field. Example: *What is the question you have for the claims specialist?*
Comments:		Rep: You may also type any comments you feel are helpful.
Advise the caller: A claims specialist will respond to this inquiry within 48 business hours. The response may be via e-mail or phone call. Business hours are considered Monday - Friday from 8am - 8pm eastern time. When finished, click the "Submit Claim Inquiry" button to submit this inquiry. You may choose Cancel to clear the form and cancel sending.
* Required Field