Contact Form



With this program, we fight to get you a positive financial result. If we cannot find errors equal to or greater than our total billing, then OUR SERVICE IS FREE. Whether you are looking to dispute a medical bill, conduct an audit, or make your business’ medical billing more efficient, MRS is here to help.

Please take a moment to complete the form below and our consultant will contact you to become your company’s personal medical bill cost savings consultant.


First Name (required)

Last Name (required)

Your Email (required)

Phone Number (required)

Who Are You? (required)

Service Needed (required)

Is the bill In collections? YesNo


What type of bill are you inquiring about? (may select more than one) (required)

Hospital Bill

Inpatient HospitalOutpatient HospitalNursing HomeRehab FacilityBehavorial Health/Mental Health



Provider Bill

PhysicianSurgeonAnesthesiologistLab/PathologyRadiologyOther


Do you have insurance? YesNo


Type of plan: Individual PlanEmployer Sponsored Plan

Insurance Company Name:


(if Employer Sponsored Plan selected)

Name of Employer


Have you setup payment arrangements? YesNo

Has the court served a judgement? YesNo


Have you received any financial assistance or discount?

YesNoPending Response

If you answered Yes (Amount Received)


How much is being told is your responsibility?


What amount was applied to your co-insurance?



How much was applied to your deductible?


Amount of copay or upfront costs if any?


Have you had any communication with the hospital or insurance company?
YesNo


(If Yes may choose more than one)

Written DisputeOral DisputeInsurance Appeal

Have you received a response? YesNo

Your Message (required)

Message Verification (required)
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