Member Forms & Feedback

Hill Physicians Members can access regularly used forms for claims, reimbursements, benefits and provide feedback on their experience and follow-up.

Member Forms | Member Feedback |Coordination of Benefits

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Member Forms

Member Claim Copayment History Request Hill Physicians may request members to provide a brief history of your copayments to process a claim.	Claim Copay History Form
Member Injury Treatment Letter Hill Physicians members may receive this letter when being treated for an injury.	Injury Treatment Letter
Member Injury Treatment Questionaire Hill Physicians requests members assistance in injury claim reimbursement. Returning this questionaire upon request will assist us in processing your claim.	Injury Treatment Questionaire
Member Request for Medical Records If you are planning to change doctors, or health plans, you may be asked to bring your medical records, or release them to your new doctor. Use this form for that purpose.	Release of Medical Records
Member Flu Shot Reimbursement Form 2012 Hill Physicians recommends getting your flu shot at your doctor’s office. However, if you prefer to get your flu shot at a retail location, Hill Physicians will reimburse the cost, up to $30 per Hill member.	Flu Shot Reimbursement Form
Member Zostavax Vaccination Reimbursement Hill Physicians members 60 and over who receive a shingles vaccination from physicians outside of our network may request reimbursement using this form.	Zostavax Reimbursement
Non-Medicare Member Tdap-Adacel Reimbursement Form For Members who do NOT have Medicare Part D. You may request reimbursement for the whooping cough vaccine.	Non-Medicare Tdap Reimbursement
Member Coordination of Benefits Form Members covered by more than one group health plan may be asked to fill out this online form.	Members Online COB Form
Some member forms are seasonal and may not appear on this list. If you have questions regarding a form you do not see here, please contact Customer Service...

Member Feedback

We want to hear from you. Visit our Member Feedback page here often and let us know how we are doing.

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