How to File a Claim

To process a claim, we will need the following 3 pieces of information:

1. Completed and Signed Claim Form
2. Itemized Bills
3. Explanation of Benefits (EOBs) from your Primary Insurance Carrier

These documents can be emailed, uploaded through our secure A-G Online portal, faxed or mailed to:

A-G Administrators, Inc.
Attn: Claims Department
P.O. Box 979
Valley Forge, PA 19482
(610) 933-4122 Fax
(610) 933-0800 Phone
(800) 634-8628 (Toll Free)
claims@agadm.com

1. The Claim Form enables us to open a claim for the treatment of your injury. To avoid delays in claim processing please be sure the “other insurance” portion of the claim form is completed in full. The claim form must be signed by an official in your organization such as an administrator, coach, or athletic trainer.

K-12 Claims – Click here

Youth Sports & Other Special Risk Claims – Click Here

College & University Claims – Click Here

2. Itemized Bills: Please include copies of all medical bills, showing the name and address of the provider of service, date of service, type of service and the charges. We typically require a CMS-1500 (HICF) or UB04 form from the provider (they will know what these are). Account statements or “balance due” statements are helpful, but do not contain all the information needed to process the charges.

3. Explanation of Benefits (EOB): If you have other medical insurance, all medical bills must be first submitted to that carrier for their determination of eligibility. If the charges are not paid in full by the other medical insurance carrier we will need to see a copy of the “Explanation of Benefits” (EOB) from that
carrier prior to issuing benefits from this office. If you have no primary medical insurance, the need for an “EOB” will not be applicable to your claim.