We'll take your medical bill from here.

Tell us about your bill and we’ll find the best way to lower what you owe, then handle the process for you.

Pay us a fee only if we lower your bill.

“Thank you so much for reducing my bill! This is such a great service. I appreciate all the efforts and communications.”

Sam A., CareRoute customer

Step 1 of 4About 2 minutes left

Person Completing This Form

Important: Patient name, date of birth, and address must be the patient's. Your email can be different, you can be the point of contact even if you're not the patient. If you're signing for someone else, we'll guide you through what's needed.

Patient Information

These two details let us check whether you qualify for financial assistance, which can provide significant bill reduction. If we believe you qualify, we will request your consent and some more details to pursue assistance.

Your provider

Insurance

Your bill

One provider's bill per submission. Have bills from other providers? You can submit those right after this one.

Service Agreement

Authorize CareRoute to pursue bill reduction with your provider, insurer, or other parties as needed

You pay 25% of what we save you, and only if we lower your bill. Example: we cut your bill by $400, you pay $100 and keep $300. The fee tops out at $1,000, which only applies if we save you more than $4,000.

Signature

Sign as it appears on your ID (driver's license, etc.)

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