If you have an Explanation of Benefits (EOB) for an infusion service from one of the following, you can be paid for it.

1. Hospital Outpatient
2. Home Healthcare Showing Drug, Medication, Units and Cost
3. Specialty Pharmacy Showing Drug, Medication, Units and Cost

Complete your contact information below for instructions on how to send for payment.

Unique insurance companies will be paid $20.00
or Unique providers (different hospitals, home care services, etc) $20.00
or Unique medications (different medications or drugs) $20.00

 

EOB upload

Please complete the form below to get information on how to upload an infusion related Explanation of Benefits (eob)
  • Please type out the name of the medication that you received to see if your EOB qualifies for payment