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THIRD PARTY COLLECTION PROGRAM

TO ALL REYNOLDS HOSPITAL CUSTOMERS

Reporting other health insurance is required by federal law. In order to meet this requirement, Reynolds Hospital staff will be asking those customers who do not have a current Insurance Verification Card to complete DD Form 2569.

DD Form 2569 is a record for other health insurance and must be filled out annually. Staff at the clinicís front desk and pharmacy will be asking for your verification card on each visit. You will be asked to fill out the insurance form, if you do not have a verification form or did not bring it with you. Filling the form out takes 2-3 minutes, please ensure the form is filled out completely. After completing the form, you will receive your insurance verification card.


Third Party Collection Form



To avoid delays remember to bring your insurance verification card and ID card whenever you come to Reynolds .


For assistance, come to the Treasurerís Office next to TRICARE Service Center or call 558-2793.


We appreciate your time and assistance in helping us meet this mission.



4301 Wilson Street Fort Sill, Oklahoma 73503-78 | Phone: (580) 558-2800 or 558-2801 |

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