Under what circumstances will I need to file a claim?
You typically will not need to file claims when you seek services from participating health care professionals, hospitals, and facilities. However, if you do not present your health plan ID card when services are received or if you receive treatment from a nonparticipating provider, you may need to submit a claim.
My claim has been denied and I don’t agree with the decision. What should I do?
Start by discussing your problem with a Member Services representative. Most problems can be resolved this way. Should you decide further action is necessary, the Member Services representative can help you start the appeal/grievance process.