This is an attempt to collect a debt. Any information will be used for that purpose. This communication is from a debt collector.

Calls to and from this company may be monitored and/or recorded.
I Accept

Medical Insurance Information

Have a medical bill and insurance? We're here to help.

Questions Regarding A Medical Bill

If you had medical insurance and received a bill from us that you believe should have been covered, please complete the form below or Contact Us

  • 1. General Account Information

  • 2. Insurance Information

  • 3. Legal Information

  • 4. Telephone Disclaimer

  • By checking this box, you are confirming that you are the named individual on this account and are authorized to review and discuss any personal information contained in the account. You further authorize Diversified Adjustment Service, Inc., representatives to contact you at by telephone at any and all numbers you have provided to discuss the account, including but not limited to contact via prerecorded messages and calls made by an automated telephone dialing system. You agree and confirm that the telephone number you provide belongs to you.
  • 5. Email Disclaimer

  • You agree that Diversified Adjustment Service, Inc. may from time to time make calls and/or send text messages to you at any telephone number associated with your account, including wireless telephone numbers that could result in charges to you. You hereby confirm that any number you provide belongs to you. The manner in which these calls or text messages are made to you may include, but is not limited to, the use of prerecorded/artificial voice messages and/or automatic telephone dialing system. You further agree that Diversified Adjustment Service, Inc. may send e-mails to you at any e-mail address you provide us or use other electronic means of communication to the extent permitted by law. You agree and acknowledge that any e-mail address or any other electronic address that you provide is your private address and is not accessible to unauthorized third parties. You agree and acknowledge that you have requested that we send the document(s) you have requested to you at the e-mail address you have provided. Consent may be revoked at any time and by any reasonable means.
  • 6. Comments / Document Attachments

  • Please attach a copy of your health insurance card (both sides) below
    Drop files here or

Call 1.800.279.3733 to learn more about how Diversified Adjustment Service can help your business.