DEAr mr. knight,
thAnk you For joining quEst hEAlth insurAnCE.ACCorDing to our rECorDs, you signED up For thE golDCovErAgE poliCy onDECEmBEr 7. golDCovErAgE Allows you to ClAim Full CompEnsAtion For Any trEAtmEnt or sErviCE proviDED At An ACCrEDitED hospitAl or DoCtor’s CliniC, inCluDing AmBulAnCE sErviCEs, hospitAl ACCommoDAtion ChArgEs, AnD surgEry FEEs.* For A Full list oF ACCrEDitED FACilitiEs, plEAsE visit our wEBsitE At www. quEsthEAlthCArE.Com/wEstCoAst.
to FilE A ClAim, plEAsE Fill out A quEst hEAlth insurAnCEClAim Form AnD mAil it to thE ADDrEss listED BElow. Forms CAn BE DownloADED From thE wEBsitE or piCkED up From your loCAl quEst hEAlth insurAnCE BrAnCh.All ClAims must BE ACCompAniED By thE originAl rECEipt signED By thE hEAlth proFEssionAl who proviDED thE sErviCE or trEAtmEnt. plEAsE sEnD Forms to:
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wE priDE oursElvEs on BEing rEsponsivE to CustomEr nEEDs, so plEAsE rEst AssurED thAt wE will AlwAys Do our BEst to proviDE you with FriEnDly, hElpFul, AnD EFFiCiEnt sErviCE. shoulD you hAvE Any quEriEs or ConCErns ABout quEst hEAlth inusrAnCE or your pArtiCulAr poliCy, plEAsE Do not hEsitAtE to ContACt thE quEst hEAlth insurAnCE CustomEr hElplinE At 1-800-007-008.
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CustomEr rElAtions mAnAgEr
* plEAsE notE thAt A mAnDAtory 12-month wAiting pErioD AppliEs For All prEgnAnCy AnD DEntAl sErviCEs. this mEAns thAt in thE First 12 months oF your poliCy, you will not BE EligiBlE to ClAim on trEAtmEnts AnD sErviCEs rElAtED to thEsE mEDiCAl issuEs.
quEst hEAlth insurAnCEClAim Form
CustomEr numBEr:128897
CustomEr nAmE: grEgory knight
CustomErADDrEss:Apt. 19C thE wAlton, 18-22BurnsiDE lAnE, wEstlAkE,EugEnE, or
mEDiCAl sErviCE / trEAtmEnt:routinE hEAlth ChECkup
DAtE rECEivED: jAnuAry 11, 2010
nAmE oF hospitAl /CliniC: loFtus mEDiCAlCEntEr
nAmE oF hEAlth proFEssionAl: Dr.CArlA johnson
i guArAntEE thAt thE ABovE DEtAils ArE ACCurAtE to thE BEst oF my knowlEDgE.
CustomEr signAturE: grEgory knight
DAtE signED: jAnuAry 14, 2010
whEn DiD mr. knight proBABly suBmit thE FormA．DECEmBEr 7
B．DECEmBEr 12
C．jAnuAry 11
D．jAnuAry 14