Page 18 - EPO_Member_Kit

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Claims
Our affiliated providers bill us directly and therefore most claims transactions are transparent to
you with you only paying for your cost-sharing amounts. But depending on the type of plan you
have, you may receive a bill from the provider for your cost-sharing responsibilities, such as
coinsurance or deductible. On the other hand, if you receive a bill from one of our affiliated
providers and your plan does not have these specific cost-sharing responsibilities, let us know. If you
want to verify your cost-sharing responsibilities, please refer to your Group Health Insurance Policy.
If you receive care for covered services from a provider not
affiliated with Alliance, for example in an emergency, you
are responsible for submitting claims and providing payment
at the time of service if it is required.
In order to properly submit your claim, please obtain an
itemized bill from the provider and make sure it includes
the following:
• Patient’s name and Alliance ID number
• Date of service(s)
• Dollar amount charged for each service
• Procedure and diagnosis codes (you can obtain this
information from the medical provider)
• Provider’s name, address and tax identification number
If you are unsure of any of the above information, ask the provider who performed the service.
Complete information on the claim form will help to ensure timely processing. Claims should be
submitted within 90 days of the date of service, if reasonably possible, to:
Alliance Health and Life Insurance Company
Claims Division
Enrollee Reimbursement
2850 W. Grand Boulevard
Detroit, MI 48202
Explanation of Benefits (EOB)
After your claim has been processed, you will receive an Explanation of Benefits statement (EOB)
explaining how the claim was processed. The EOB will show your copay or coinsurance amounts,
the eligible amounts applied to your deductible and any services that were not covered.
The EOB is not a bill, but an explanation of how your claim was processed. If you have questions
about your EOB or how a claim was paid, contact Client Services department at
(313) 664-7010
or
toll-free at
(888) 999-4347
. You may also get claim processing details by accessing Online Services
at
hap.org
.
Claims received more than 12 months after the date of service will be denied.