Forms
Submit your completed Claim Form to:
FAX: (985) 898-1666
MAIL: HealthComp
PO Box 1590
Covington LA 70434
Medcom Care Management wants you to be satisfied with the service we provide. As we strive for excellence, we would like the opportunity to respond to your concerns and complaints. To submit a written complaint, download and print the Medcom Care Management complaint form, click the link below.
Medcom Care Management Complaint Form
Mail a written complaint, or deliver the complaint in person, to: Medcom Care Management P.O. Box 1751 2100 Covington Centre Covington, LA 70434
If you prefer to contact us by phone, call the Medcom Care Management at (800) 643-4416 or you may complete the Customer Satisfaction Survey
Healthcare & Dependent Care Reimbursement Account Claim Form
What you need to submit with your claim form:
Healthcare Reimbursement Account
- Completed claim form
- EOB statements indicating the deductible, co-insurance and amounts not covered by any medical/dental plans under which the employee or eligible dependents are covered
- Fully itemized bills including dates of service, name of claimant, type of service from a doctor, dentist, pharmacy or other supplier
- Copies of prescription label that includes price and receipt
Dependent Care Reimbursement Account
- Completed claim form only
Orthodontia Reimbursement Account
- Please submit claims using the Healthcare & Dependent Care Reimbursement Account Claim Form above
How to submit your claim form:
For faster processing, fax the completed FSA/HRA Claim Reimbursement Form and receipts to:
FAX: (866) 635-1329
EMAIL: Flex@HealthComp.com
