Speak Up! You Have a Voice in Your Health Benefits
Making the most of your benefits means not only doing your research and selecting the plan that is best for you and your family, but also managing your plan by being aware of any changes and staying on top of claims and charges. Keep records of your doctor's visits, medical bills and health history. Plan for Your Health's Navigating Your Health Benefits can help.
CLAIM STATUS
Claim status
Call or check the website of your benefits provider to check on your
claim, including the amount you owe and payment due date. Some health
plans offer members a personalized web page, listing all your benefits
information in one place.
APPEAL
Appealing a decision
If all or part of your claim is denied and you believe this decision is
in error, you may use the
appeals process to initiate
a review of the claim. Your plan will have a process for appealing a
benefit decision with which you disagree. In some cases, your plan may
not have had enough information to make a decision, and the appeals
process gives you the opportunity to provide that information. To find
out about your plan's appeals process, including any time restrictions,
visit the health plan's website or call the toll-free number on your ID
card. Under some health insurance plans, the Explanation of Benefits
(EOB) form you receive after the service is performed includes
information on the appeals process.
CUSTOMER SERVICE
Customer Service
Most plans offer toll-free phone numbers to contact the customer service department. Information can be found - and sometimes submitted - on your health benefit providers' website or your ID card.