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Get Tdi Fillable Forms For Mediation

149091 Austin, TX 78714-9091 Fax: 512-475-1771 E-mail: ConsumerProtection tdi.texas.gov Please provide the following information and sign at the bottom. Bolded items are required. You can also attach copies of bills that are in dispute and the explanations of benefits (EOB) from the insurance company showing the amount the insurance company paid. Enrollee Contact Information Name (first, middle, last) Address.

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