ClaimReturn - Medical Cost Containment Services

Appeals Form

If you wish to file an appeal of a ClaimReturn finding, please use this form to submit any pertinent information. We will respond to you as soon as your appeal has been evaluated by our team.

If for some reason you are not able to work with this form, please email your appeal with the same information as below to

NOTE: Fields marked by * are required, you will not be able to submit the form without all of the required information.


Include a written summary of your dispute and the documentation to support your dispute.
You can upload any files you wish to support your appeal. Uploads are limited to Word, Excel or PDF documents.
You can select and submit multiple files if necessary.