Fill out the customer information below and we will communicate with you via email or phone, depending on your preference, to obtain a copy of your medical bills.
This section is for communication with you, the customer. Please be sure to provide accurate information.
Work through the following steps and you’ll be well on your way to significant savings (we average a 59% savings on medical bills).
Here’s the sequence of events:
IMPORTANT:Please be sure that the above information is for the primary contact (customer).
The Primary Contact may be the Patient, Legal Guardian or Representative of the Patient’s Estate. This contact information is used for communication with the customer filling out the form. Patient information is included in the HIPAA Authorization section.
You will need to sign a HIPPA Release Agreement first that Authorizes Ducit to review Patient Information. By Federal Law, Patient Information must be kept strictly confidential and this Agreement explains Ducit’s responsibilities while we are helping you.
We work hard to keep your information safe. With an perfect track record, SSL 128 Bit Encrypted Security and a Better Business Bureau accreditation you can have confidence that we have your best interest in mind. Let us help you with you save money on your medical bills.