Third Party Liability Assistance Form

 

ElevatePFS can help ensure accurate and timely payment for your accident and injury-related care. We partner with health systems to investigate the details of your accident, so that accident-related insurance pays all or part of your hospital bill. If you were treated for injuries arising out of an accident, please fill out the form below and a representative from our TPL team will contact you if needed. 

TPL Form
Patient Name
Patient Name
Patient was the:
Attorney Name
Attorney Name
First
Last
Adjuster's Name
Adjuster's Name
First
Last
Other Parties' Adjuster's Name
Other Parties' Adjuster's Name
First
Last

Headquarters

25700 Interstate 45 North, Suite 300
Spring, Texas 77386

Phone

Sales

800.835.7474

Patient Billing

866.770.2116

Eligibility Assistance

866.402.3630

Disability Advocates

866.534.6699

Third Party Liability

877.268.1705

Workers' Compensation

800.544.9925