File a Cancer Claim
To begin your claim, contact Midwest Heritage at 515-343-5047. A customer service representative will ask you for the following information to get the claim form started, and then mail the forms to you for completion.
- Employee name, social security number, and store location
- Current phone number, address and email address to contact claimant
When an employee receives the claim form from Midwest Heritage:
- Complete the highlighted fields on the form
- Physician will need to complete their section
- Attach a copy of the pathology report showing the cancer diagnosis
- Attach copies of itemized bills with diagnosis codes (a UB Form or 1500 Form works best)
Send complete the claim form with the appropriate itemized bills to Midwest Heritage Insurance, 1025 Braden Ave., P.O. Box 737, Chariton, Iowa 50049.