What is a claim?
Who is this for?
If you go to a doctor that's not in your network, you'll need to know the process of getting reimbursed for the services you received.
Simply put, a claim is a request to be paid for a health care service.
When you visit your doctor for a check-up, your doctor submits a claim to your insurance company. Your insurance company reviews the claim, approves the claim and then pays your doctor.
What you need to do
Normally, your health care professionals will take care of your claims. However, if you visit a doctor outside of your network, you may have to submit the claim yourself.
In those situations, you'll pay the full cost of the service. Then you'll submit a claim to us. We’ll reimburse you for the portion covered by your health care plan when we approve your claim.
You'll need separate claims for each type of service you want to be reimbursed for. Let's say you get sick and you decide to visit an out-of-network doctor. The doctor examines you and gives you two prescriptions. You pay the full cost of the doctor's visit before you leave. Then, you go to the pharmacy. You pay the full cost again when you pick up your prescriptions.
When you get home, you'll need to fill out two claims: one for the doctor's visit and one for the prescriptions. It's okay to have multiple prescriptions on the same claim because they came from the same pharmacy.
What is Master Medical?
Master Medical is a plan that helps you pay for the services your basic health care plan doesn't cover. You can add it to the Blue Traditional coverage you get through your employer.