Delaware Form to petition for health care reimbursement arbitration

• Category: Delaware Insurance - Arbitration
• State: Delaware
• Control #: DE-18-AB
• Format: Word

Description

Form to petition for health care reimbursement arbitration The Delaware Form to petition for health care reimbursement arbitration is a legal document that is used to initiate a dispute resolution process between a patient and a health care provider. The form is used by patients to request reimbursement for health care services they have paid for out-of-pocket. The form is available from the Delaware Department of Insurance and is used when a patient is unable to resolve an issue with their health care provider through standard means. The Delaware Form to petition for health care reimbursement arbitration is divided into two parts. Part I is used to providing information about the patient, the health care provider, and the dispute that is being arbitrated. Part II is used to provide information about the arbitration process and how the patient wishes the dispute to be resolved. The Delaware Form to petition for health care reimbursement arbitration is available in two formats: the Traditional Petition Form and the Simplified Petition Form. The Traditional Petition Form is used for disputes involving more than one health care provider and/or for disputes involving complex issues. The Simplified Petition Form is used for disputes involving one health care provider and/or for disputes involving simple issues. In both formats, the patient must provide detailed information about the dispute and the requested resolution. Once the form is completed and submitted to the Delaware Department of Insurance, a qualified arbitrator will be assigned to the case and a hearing date and time will be set.

The Delaware Form to petition for health care reimbursement arbitration is a legal document that is used to initiate a dispute resolution process between a patient and a health care provider. The form is used by patients to request reimbursement for health care services they have paid for out-of-pocket. The form is available from the Delaware Department of Insurance and is used when a patient is unable to resolve an issue with their health care provider through standard means. The Delaware Form to petition for health care reimbursement arbitration is divided into two parts. Part I is used to providing information about the patient, the health care provider, and the dispute that is being arbitrated. Part II is used to provide information about the arbitration process and how the patient wishes the dispute to be resolved. The Delaware Form to petition for health care reimbursement arbitration is available in two formats: the Traditional Petition Form and the Simplified Petition Form. The Traditional Petition Form is used for disputes involving more than one health care provider and/or for disputes involving complex issues. The Simplified Petition Form is used for disputes involving one health care provider and/or for disputes involving simple issues. In both formats, the patient must provide detailed information about the dispute and the requested resolution. Once the form is completed and submitted to the Delaware Department of Insurance, a qualified arbitrator will be assigned to the case and a hearing date and time will be set.