J.M. Berenguer and Associates, Inc.

Customer Service Request

Subscriber Name:
Subscriber #:
E-mail:
D.O.B.:
Employer name:
Dependent name:
ID#:
D.O.B. (if applicable):
Statement of request:

 

if this is a claim issue please fill ou t the Member authorization form and fax back to 786-497-0899.
(to fill out this form you´ll need Adobe Acrobat Reader, if you don´t have it, you can download for free

Also fax in actual claim and insurance carrier explanation of benefit if available.