I hereby authorize representatives of Resolve Financial Solutions to request and receive protected health information (PHI) about me to assist me in auditing, filing, appealing and negotiating my health insurance benefits and medical charges.
to release any information concerning an insurance claim to Resolve Financial Solutions for the purpose of validating and determining the benefit payable.
The above organizations may include but are not limited to:
The specific information to be disclosed from medical providers includes any information necessary to manage my medical bills, including procedure codes, diagnosis codes, providers and date of service, payments made by my insurance company and any financial matters regarding my account.
Iauthorize my insurance company to speak to and correspond with any agent of Resolve Financial Solutions in connection with claims filed by them on my behalf.
The specific information to be disclosed from my insurance companies include copies of claims received from medical providers, Explanation of Benefits to detail payment, denial and adjustment amounts.
I may revoke this authorization at any time by notifying Resolve Financial Solutions in writing or via email. This authorization expires one year from its inception or if my agreement with Resolve Financial Solutions is terminated.