We're sorry if you've suffered an accident, illness or injury or have a claim on your insurance policy. That's why you have insurance, to protect you when something bad happens. We'll guide you on every step along the way.
What to do if you need to seek Treatment?
In an emergency, you will want to seek treatment ASAP and can find the nearest provider on the insurance company's website or phone app. Many carriers now have FREE apps to locate providers IN YOUR NETWORK. (NOTE: Healthiest You can do this for you AND track your deductibles and out of pocket costs as well as find you the lowest cost to purchase your prescriptions. Learn more here.
In the case of most health insurance claims, you will most likely not delay in seeking medical treatment, and the provider (the hospital or Dr.'s office) will file the claim to your health insurance carrier. Just be sure to show them your ID card when seeking treatment. If you have LOST YOUR CARD, don't panic! Just call our office and we can order a new one or tell you how to print a temp ID card (when available.) Remember, as long as you have paid your premium on time, you have insurance, and the Dr.'s office should be able to verify this with the insurance company.
Most dental plans work the same as health insurance - simply show your ID card to your dentist office at the time of service. They should mail in the claim for you, and many of them will get a predetermination if you need a large amount of work done. This will give you an estimate of what the insurance will pay and what you can expect to pay.
In the case of critical illness, cancer, and other type of supplemental insurance plans, you will need to file the claim with the insurance carrier. Most of these policies will pay over and above your other insurance plans, and they will most often pay YOU directly, not the provider. Again, our office can assist you and direct you to how to file this claim.
In the case of disability, long term care, and life insurance, feel free to contact our office to get the paperwork started. You will need to submit the claim form and do some paperwork, but our office can assist you in getting the ball rolling. We are here to Help! Most disability and LTC claims require that a waiting period be satisfied before starting a claim; however, some LTC providers encourage you to start the process early. So if in doubt, call us!
There are a few and probably rare situations where it makes sense to not file a claim. Keeping your insurance record clean will probably keep your rates down. If you have a High Deductible Health Plan (HSA type medical insurance), you probably don't want to submit small bills or claims if you have no chance of coming close to your calendar year deductible. Be sure to discuss this with the provider...whether it is for your regular chiropractic adjustments, monthly prescription, or trip to the dr. for a cold. They will automatically bill your insurance carrier unless you tell them otherwise.
If this is a consideration, read this special report before you make that decision.
To begin, please contact the insurance company directly to put them on notice of the claim. We will then be notified of your claim by the insurance company.
- If you have a claim and would like our assistance, we will be happy to speak with you. Because of Privacy Laws, most insurance carriers will not discuss specifics of a claim with any agent without prior written or verbal notification from the insured. In most cases, you will need to speak directly with the Insurance Carrier to report the details, but we can help to make sure that your claim is processed correctly, review your E.O.B. (Explanation of Benefits) and help you to understand how the claim was paid. Simply contact our office for assistance.
- If you claim is not resolved to your satisfaction, you have some recourse: First you can file an Appeal with the insurance company; Second, you can file a formal appeal with the state department of insurance, and third, you can hire an independent Patient Advocate to help negotiate the claim on your behalf.