Complete
a Reimbursement Request
form and attach documentation related to the services being
claimed. See the instructions page on the specific claim form
for additional information regarding what documentation is needed.
Please note that at no time are the following items eligible documentation:
check copies
credit card receipts
balance due statements
collection notices
bank statements
Ensure that all documents are legible. Once received, claims are
scanned (similar to photocopying). Documents that are too light,
too dark or fonts that are too small will cause delay. Please do
not highlight documents as this will not show on scanned images.
Be sure that your Reimbursement Request Form is complete, signed
and dated. Submit this form along with your supporting documentation
to:
Personal Choice Account
PO Box 3199
Portland, OR 97208-3199
Or fax to: (503) 225-5353 or (800) 979-8987
Retain a copy of the reimbursement request form and copies of supporting
documents for your records, as those submitted will not be returned.
Copies of your claim can be ordered for $1.00 per page.
Note that all reimbursements are paid to you, and may not be assigned
to any other person. Checks and Explanations of Payment will be
mailed to the home address on file. Any address changes
must be submitted through your employer.
Failure to provide the needed information and completed
forms may result in delay or denial of your claim. To maintain a
timely turnaround of claims, we do not call to discuss claims or
documentation. Any denial will be done in writing.
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