Step

1

  • Your healthcare provider completes the enrollment form and faxes it to 1-855-881-6864

Step

2

  • You provide consent to enroll by signing the enrollment form

What Happens Next?

A case manager will reach out to you in 1-2 business days to discuss how they can support you. Together, you can review:

  • Summary of benefits and out-of-pocket costs
  • Any requirements such as prior authorizations or an appeals process
  • Eligibility for our financial assistance programs