How
To File A Claim
Most
health care providers bill the Trust Office directly. The Trust Office then
processes the claim and provides you with an Explanation of Benefits (EOB)
describing what this plan paid, the PPO discount, if applicable, and what is
owed as part of the annual deductible, copayment, coinsurance, and noncovered
expenses.
If services or supplies are
received from a provider that does
not
bill the Trust Office directly, or if you have another health care plan that is
primary, the following guidelines should be followed:
- Submit
the provider’s itemized bill to the Trust Office. The address is on the
back cover of this booklet.
- If
the individual is covered under another health care plan or Medicare, and the
other plan or Medicare is the “primary” plan (please see Coordination of
Benefits), include
the primary plan’s Explanation of Benefits with the provider’s
itemized bill. The Explanation of Benefits and the provider’s itemized
bill must correspond. Inaccurate or incomplete information can create
unnecessary paperwork and delay processing.
- If
the primary plan has prescription drug coverage, submit the claim to the primary
plan first. Then submit the primary plan’s Explanation of Benefits or the
prescription drug copayment receipt to the Trust Office for additional
reimbursement.
- Claims
for services received outside of the U.S. are converted to U.S. currency based
upon the conversion rate at the time of service and then paid directly to the
participant. Itemized bills must be translated into English before being
submitted to the Trust
Office.
If
prescription drugs are purchased from a nonparticipating pharmacy, complete a
Prescription Drug Reimbursement Form. These forms are available from Medco
Health. No claim form is required with Medco Health Retail Pharmacy Program or
Medco By Mail. See also time
loss or life insurance.
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