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Emergency Room Charges
Please complete this claim form to request a free case evaluation from a lawyer listed on LawyersandSettlements.com.
(who overcharged you?)
Describe your complaint:
(briefly describe the damages you have suffered)
What medical treatment triggered your Emergency Room visit?
What treatment did you receive at the hospital?
Date of your hospital visit?
Were you seen in the same Emergency Room previously?
Did you have medical insurance which covered your emergency visit?
If you had insurance, did you receive an Explanation of Benefits (EOB) for your hospital visit?
What were the hospital’s total charges prior to any discounts or payments?
What is your share of the hospital's bill:
Do you feel the hospital’s billed charges were excessive and unfair?
Do you still maintain hospital billing statements and paperwork from your insurer?
Confirm email address:
Best time & way to contact you:
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