This form allows you to submit your insurance information directly to our billing company. If you have any questions, please contact them at 660-829-4046, Monday through Friday, 8:00 AM to 4:00 PM. Alternatively, you can make a copy of your insurance cards and fax them to 660-829-4021 or email them to help@colecampems.com.
In the "Additional Information" section, please include any relevant details such as if this was a car accident, work-related injury (including your employer), or any other information you believe is important. Our goal is to bill your insurance in the most efficient way to ensure prompt payment.