Florida Academy of Physician Assistants
Report of Reimbursement Problem

The Florida Academy is seeking to establish a database of reimbursement issues and problems that PAs here in Florida are experiencing. This information is vital to our legislative effort to secure reimbursement for PAs for the services they provide. Without adequate input from PAs across the state of Florida, it will make the task of proving the existence of problems and the need for actions to the legislators and regulating bodies very difficult for our Legislative and Governmental Affairs Committee. So if you are having ANY reimbursement problems, please provide the information to us by one of the methods presented below.

You may complete the online form below, and make sure that you include all information.

Download the form, print it and then fax to the office.

Full Name (required):
Street Address:
City, ST, Zip:
Practice Setting:
FAPA Member: Yes     No
Phone:
Email (required):
Insurance Company Involved:
Describe Problem
(Please be specific):
Person with whom you spoke:
Person's phone & ext:
Your question(s) to them:
Person's Response:
Can you provide documentation, ie. EOBs, letters of denial?: Yes     No