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9
Filing Claims
Providers will bill HAP directly. Whenever you visit a doctor, you will only pay your cost-sharing
amounts. If you get a bill that isn’t for your cost-sharing amounts, please let us know right away and
send us the bill.
You should not get bills from providers for medical charges beyond your control. For example, if you
get care from a non-affiliated doctor in an emergency, this is beyond your control. This is called “hold
harmless.” If this happens, you can send the detailed bill to us for possible reimbursement.
Please get a detailed bill from the doctor and make sure it includes the following:
• Patient’s name and ID card number
• Date of service(s)
• Dollar amount charged for each service
• Procedure and diagnosis codes (you can get these from the doctor)
• Doctor’s name, address and tax identification number
If you aren’t sure of any of the above information, ask the doctor who performed the service. Complete
information on the claim form will help with timely processing. If possible, claims should be submitted
within 90 days of the date of service to:
HAP Claims Division
Member Reimbursement
2850 W. Grand Boulevard
Detroit, MI 48202
Explanation of Benefits
You may get an Explanation of Benefits (EOB) in the mail after we process your claim. 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, call Customer Service at the number on your ID card. You may also
get claim processing details when you log in at
hap.org
.
Coverage While Traveling
Preventive services performed outside of your network are not covered by your plan.
Coverage While Traveling
Remember, your plan covers urgent and emergency care worldwide. But if you ever become ill or injured
while traveling more than 100 miles away from home, or outside the U.S., one call can connect you to
Assist America®’s 24/7 operations center. Our partner, Assist America, arranges and pays for all services
provided, including emergency medical evacuation, compassionate visits and medical consultation or
referrals. For a complete listing of Assist America’s services, call
(800) 872-1414
.
Prescriptions While Traveling
Check your prescriptions before you leave home. If your medications are low, be sure to get a refill.
We also have a national network of pharmacies to use when you are traveling, including Rite Aid,
Target®, Walgreens, Walmart® and CVS.