Claim History Forms



    Authorization to Release Confidential Claim Information (Individual Physician)
    This Claims History Report is free for insured physicians of MDAdvantage. Those who are no longer covered can follow the instructions on the form to mail in your payment of $35.00.

    Request for Group Policy Physician Claim History Information
    There is a $35 fee for each physician or paraprofessional on your Group Policy, subject to a maximum fee of $150. For active MDAdvantage Groups, the fee is waived. Please follow the instructions on the form to mail in your payment.