CCHI Consumer Assistance Client Authorization Form & Release
The Colorado Consumer Health Initiative (CCHI) Consumer Assistance Program helps consumers navigate and resolve problems with health insurance claims and billing issues.
By submitting this form, you:
-give CCHI your permission to speak on your behalf with health care providers, insurance companies, state agencies, and other professionals about health care services you have received and health care billing issues you experience
-give your permission for your records to be shared by fax, email, or mail with CCHI.
-give your permission for your records to be entered in CCHI client relation management system and opt in to receive emails from CCHI
-understand that that CCHI provides navigation support and services to help resolve problems presented by the client
-understand that CCHI is not a law firm and does not provide legal advice
-understand that CCHI will work to the best of its ability to resolve your issue but cannot guarantee the outcome
-agree to hold CCHI harmless for the result of negotiations completed on your behalf
CCHI is committed to protecting your privacy and maintains high standards of confidentiality and discretion. You may cancel your consent granted through this form in writing at any time and acknowledge that you will notify Colorado Consumer Health Initiative if you choose to cancel your consent.