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Reimbursement Request

How to ask us to pay you back or to pay a bill you have received

 

If you received a bill for medical services or if you paid for medications that should be covered by the plan, you can request that we pay for the invoice or request a reimbursement.

 

Send us your request for payment, along with your bill and/or documentation of any payment you have made. Even if it is not a requirement, we suggest you fill out our claim form to make your request for payment. This form, which you can find below, will help us process the information faster, with all the information we need to make a decision. It’s also a good idea to make a copy of your bill and receipts for your personal records.

 

Medical Services

 

Download and complete the form according to your plan for medical services reimbursement. Once the form is completed, send your request for payment of medical services along with any invoices or receipts by mail to the following address:

 

 

Medicare y Mucho Más
Claims Department
PO Box 71114
San Juan, PR 00936-8014
Icon PDFReimbursement Form
PMC Medicare Choice
Claims Department
PO Box 366292
San Juan, PR 00936-6292
Icon PDFReimbursement Form
First+Plus
Claims Department
PO Box 71114
San Juan, PR 00936-8014
Icon PDFReimbursement Form

 

 

Pharmacy Services

 

Download and complete the form according to your plan for a pharmacy reimbursement. Once the form is completed, send your request for pharmacy reimbursement along with any invoices or receipts by mail or fax to the following address:

Medicare y Mucho Más
Pharmacy Department
PO Box 71114
San Juan, PR 00936-8014
Fax: 787-300-5503
Icon PDFReimbursement Form
PMC Medicare Choice
Pharmacy Department
PO Box 366292
San Juan, PR 00936-6292
Fax: 787-625-3370
Icon PDFReimbursement Form
First+Plus
Pharmacy Department
PO Box 71114
San Juan, PR 00936-8014
Fax: 787-300-5503
Icon PDFReimbursement Form

You can also submit your application by visiting any of our Service Offices.

 

You must submit your claim within a period of 12 months from the date when you received the service, item, or medication. When the request arrives to the plan, it must be processed within 14 calendar days. If the plan’s decision is favorable to you, the plan must make the payment within a period of 14 calendar days after receiving the request.

 

For more details on how to submit a claim in writing, you can refer to the Claims Process that is explained in Chapter 9 of the Evidence of Coverage of your plan.

 

For more information or help in submitting your request, you can contact Member Services.

 
 
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