Important announcement: Following the 2026 merger of Patient Advocate Foundation and the PAN Foundation, this website is now part of Patient Advocate Foundation and remains active during the transition. If you are currently receiving assistance, or would like to apply, visit TotalAssist.org to find your fund and access your account. For help by phone, call 866-512-3861, Monday through Friday, 8:30am to 5:30pm ET. Learn more about the merger and our organization.

CMS-1500 health insurance claim form

During our transition, where to find information about:

Our merged organization: uniting.patientadvocate.org
Financial assistance: totalassist.org
Additional direct patient services and resources: patientadvocate.org
Education: panfoundation.org and education.patientadvocate.org
Clinical trials education: clinicaltrials.panfoundation.org
Advocacy: npaf.org
Research: patientinsightinstitute.org

Download this form to submit a medical or pharmacy claim to the PAN Foundation.

How to file a claim:

CMS-1500 Form (pdf 954.12 KB)

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