Surgical Cost Projection Request

Please start by filling out your information. Depending on your position, the form will auto fill in the information to the right, so you won’t have to duplicate details. By submitting the form below, your claimant’s case information will be used by our experienced workers’ compensation staff to outline a thorough, itemized cost projection for non-urgent surgical procedures.

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Your Information

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Claimant

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Procedure

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File Upload
Drop a file here or click to upload Choose File
Maximum upload size: 2.1MB

Next Steps

CompAlliance will contact your indicated provider and available facilities to determine next steps.

The results of the projection service will be delivered to aid in setting accurate reserves and provide a clear picture of your claimant's expected care selections including forecasting charges, appropriate allowances, and a summary of ancillary charges expected for the individual procedure.

Surgical Cost Projections are all individually processed by our experienced team of nurses and normally available in 5-10 business days. For more information contact us at SCP@CompAlliance.com.

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Adjuster
Provider
Provider Secondary Contact (if applicable)
Case Manager

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