Nursing Student Medical Claims
The Franciscan Treatment Center will facilitate all claims submissions. Note that Risk Management is available to address any concerns or questions, but all claims must be submitted by the injured party directly to Franciscan Treatment Center at the contact information below.
For all questions regarding student injury policy in the School of Nursing and Health Practices please refer to the School of Nursing and Health Practices Injury Policy or contact Kim Lottes at (415) 422-2693.
- To file a claim, please complete this Nursing Medical Claim Form.
- Bring claim form to Franciscan Treatment Center.
- Submit claim form and any associated invoices, bills, HCFA 1500 or UB92 forms to Bob McCloskey Insurance Agency following treatment.
All Claims must be submitted 90 days or as soon as possible, or within 90 days of date of injury or first treatment for the injury. Claims reported after 1 year of injury will not be considered. (Medical bill, HCFA 1500 or UB92 should be used to submit expenses.)
Franciscan Treatment Center Information:
1199 Bush Street, Suite 160
San Francisco, CA 94109
Claims Contact: Gayle Chan-Lee, email@example.com or (415) 353-6305
Bob McCloskey Insurance Agency Claims Reporting Information:
Bob McCloskey Insurance
P.O. Box 511
76 Main Street, Matawan, NJ 07747
Claims Email Address: firstname.lastname@example.org
Nationwide Toll Free Phone Number: 1 (800) 445-3126, x507
Customer Service Hours: 9 a.m.–5 p.m. (EST)