Indigo

Step 1

Primary physician

Solo practice? You're all set. Insuring a group? You'll add the rest in Step 3.

First Name*

Last Name*

Designation*

Specialty*

NPI*

Practice Name*

Practice Address* (Street Address, City, State, Zip)

Email Address*

Phone Number*

Practice Website

Practice Description*

Step 2

Insurance info

Applies to the primary physician

Do you currently have coverage for the work you are seeking to cover?*

Yes No

Will the coverage we are quoting replace any existing coverage?*

Yes No

Coverage Limits

Effective Date*

Retroactive Date*

What percentage of your practice is telemedicine?

What percentage of your practice is Aesthetic Procedures?

What percentage of your practice is pharmaceutical weight loss?

What percentage of your practice is compounded pharmaceutical weight loss?

What percentage of your practice is off-label usage of approved FDA devices or drugs?

What percentage of your practice is delivered in nursing homes?

What percentage of your practice is delivered to prisoners?

Have you had any malpractice claims in the last 10 years?*

Yes No

Step 3

Upload documents

We'll extract every provider we find — across all files you upload

Upload documents for the providers you want covered — our document processing scans every file and uses NPI verification and other signals to identify and build a profile for each provider. Up to 20 providers per submission.

Declarations pages & COIs — we'll pull every provider listed, not just the primary
Policy or coverage documents — any pages showing provider names, specialties, or coverage terms
Rosters & spreadsheets — a simple list of names, specialties, or NPIs is enough
Anything else — if it names your providers, upload it and we'll extract what we can

Upload Files

PDF, DOC, XLS — 25MB total

filename.pdf

Total physicians in this submission

Helps us verify we've captured everyone. Leave at 1 for a single physician.

Primary physician

Insurance info

Upload documents

Thank you!