Dear {{agency_name}}
We are reaching out to you because we made multiple attempts to have your gestational carrier sign the HIPAA authorization form. You have been included on those email communications, and we have yet to receive the signed form from {{surrogate_full_name}}. This is a requirement for our ACA policy placement cases who added Premium Bill Monitoring (PBM) Service. We unfortunately have to cancel the PBM service.
We are going to ask our accounting department to issue a refund on the PBM service. If you want to avoid this, please ask your gestational carrier to go to her ART Risk portal immediately and complete the required tasks. If wet signature is required, have your gestational carrier sign the form and take a picture/scan send us a copy and mail the actual signed form to our address.
If you have any questions, please contact your Dedicated Agent or Premium Bill Monitoring Billing Specialist.
Best regards,
ART Risk Financial & Insurance Solutions
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**If you wish to contact us, please do not reply to this message but instead contact one of our Client Success Liaisons at 661-257-6242 (via phone) or info@yourinsuranceresource.com (via email). For specific questions regarding your policy, please reach out to your Dedicated Agent. Replies to this message will not be read or responded to.