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Home Health Care/Adult Day-Care Claims
To file a health care claim, please complete the appropriate claim form and following the guidelines below:
Please remember to submit a signed and dated authorization with all information provided.
- Complete Part 1 and sign the Authorization to Release Information (Form NYHC0020).
- Have the attending physician complete Part 2.
- Have the home health care/adult day-care provider complete Part 3 and attach an itemized bill showing the dates, types of services, and charges incurred.
- Include an authorization signed and dated by the patient with every claim.
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Aflac New York Toll-Free:
1-800-366-3436
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