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Customer Service: (877) 210-1719
TTY users should call 711

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Evidence of Coverage Request Form

Please send me a copy of the Evidence of Coverage to:

Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.


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Last Updated 09/27/2018