Request for Review of Insurance Denial
Please complete the form below to request a review of your insurance denial. You can also request a review by emailing Hello@CubbyBeds.com and including all of the information below.
Name
*
First Name
Last Name
E-mail
*
Phone
*
Briefly explain why you were denied by insurance.
*
Have you appealed your denial?
*
Yes
No
What State do you live in?
*
Who is your Medical Equipment Supplier?
*
What is your Medical Equipment Suppliers email address?
*
What is your Medical Equipment Suppliers phone number?
*
Please upload your Insurance Denial documents.
*
Browse Files
Cancel
of
Please upload your Letter of Medical Necessity
*
Browse Files
Cancel
of
Submit
Should be Empty: