HEALTH INSURANCE RESPONSE FORM – VISA VERIFICATION

Thank you for selecting the ISO Health Insurance Plan. HealthSmart is the claim administrator of your plan. (“Claims” are formal requests for the plan to pay for services you’ve utilized, usually submitted by the providers you see.) In order to process the medical bill from your doctor, we need to verify your VISA status for the plan eligibility. Please provide the information listed below.

 

 

 


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HealthSmart
3320 West Market Street Suite 100 | Fairlawn Ohio 44333 | 800-203-4720 (tel) 806.473.3136 (fax)