Page 9 - PA_HMO_Member_Kit

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Filing Claims
Our providers bill HAP directly. Whenever you visit a provider, 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 provider 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 provider 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 provider)
• Provider’s name, address and tax identification number
If you aren’t sure of any of the above information, ask the provider who performed the service.
Complete information on the claim form will help with timely processing. Claims should be submitted
within 90 days of the date of service, if possible, to:
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 Client Services at the number on your ID card. You may also get
claim processing details by logging in at