.. Loading ..

Make a Referral

Referrals can be made by mail, fax, email or using the online form below.

Mailing Address:
MSA Services, LLC
95 Glastonbury Blvd. – Suite 216
Glastonbury, CT 06033-4453
Fax:
(860) 657-9838

Referral Form


Currently on MedicarePossibly Medicare eligible within 30 monthsNo chance of Medicare eligibility within 30 months


YesNo


Analysis of MSA AllocationAnalysis of MSA and Submission to CMSConditional Payment SearchConditional Payment Search & NegotiationSocial Security Offset Proration LanguageFuture Medical Cost Projection


YesNo