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| How do I file a claim? |
| When you have incurred covered medical
expenses, download the correct claim form for your school from
this Website, print it, complete and sign it, and mail it to
the address at the top of the claim form along with ITEMIZED
billings for your medical treatment. |
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| What is an ITEMIZED bill? |
| This is a billing given to you by the medical
provider that "itemizes" each service for which you
are billed. (The Physician’s itemized bill is called an
"HFCA 1500", the Hospital’s itemized bill is
called a "UB92") We can only process your claim with
the ITEMIZED bill. The medical provider will at times send you
a STATEMENT after you have been treated which shows how much
in total you still owe, WE CANNOT process your claim if you
send us this statement. We must have an itemized billing. The
ITEMIZED billing shows every detail of the service you received,
the STATEMENT only shows the amount due. |
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| How soon should I file my claim after my
medical treatment? |
| You should obtain a claim form and submit
it within 90 days after the date of accident or onset of illness. |
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| How long does it take for you to process
my claim? |
| If you send in a completed and signed claim
form along with itemized bills (see above), and there is no
other information we must request, processing should be done
within 21 days of receipt. |
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| Do you pay the Provider or me? |
| If your benefits were assigned to the provider
at the time of treatment, which is the usual case, we will pay
the provider. If you paid the provider at time of treatment,
indicate that on the claim form. We will then send the payment
directly to you. |
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| Will you need information from me in addition
to what I put on the claim form? |
| Yes, at times we will have to write you
and request additional information. Please respond as soon as
you receive a letter from us. Failure to respond to one of our
letters results in the claim being suspended. |
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| What other information would you need? |
| Sometimes we may need additional clarification
on how an incident occurred or we may have to order a copy of
your medical records from your Provider. This may take several
weeks. |
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| What if I have Insurance with another Company
in addition to yours? |
| If your policy requires that we are secondary
coverage to your other existing Insurance, we will consider
payment of the expenses that your other insurance does not pay.
You will need to send in your claim form with the Explanation
Of Benefits (EOB) the other company sends you which will show
what they have not covered, along with a copy of the ITEMIZED
billings. |
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| What is a "Deductible?" |
| On some plans you may have a deductible,
which is the amount the Company subtracts from the eligible
payment. This is what you pay directly to the medical provider. |
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| What is a "Co-Pay"? |
| This is also an amount that is not covered
in your plan’s Benefit Schedule. Usually it is a set percentage,
often 80%, which means the Company pays 80% and you are responsible
for 20%. Co-pays for prescription drugs may vary. Any amount
designated on your Explanation of Benefits (EOB) as what you
pay directly to your medical provider. |
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| What is "Usual & Reasonable"? |
| Usual & Reasonable is how the Company
determines if a charge by a Provider is the "usual"
charge for your area. We access the Medical Data Research Table
provided by Ingenix, Inc., to determine the normal fees and
prices generally charged in the locality where the service is
performed. The Policy will not cover the charge in excess of
Usual & Reasonable. |
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| My Plan has a PPO associated with it. What
does that mean and how does the PPO discount work? |
| We contract with groups of medical providers
who agree to charge the student a discounted fee if the student
uses their services. They are called Preferred Provider Organizations
(PPO) because they are first determined to be physicians or
hospitals of excellent reputation and distinction, and second
because they will treat you for a discounted fee. Heritage,
in return, agrees to pay the discounted fee of the PPO provider
in full. This is very important, in that it means that if you
go to a PPO provider, there should be no out-of-pocket cost
to you. If you do not go to a PPO provider, however, there are
usually penalties in the plan, which may be either increased
deductibles or larger co-pays, or both. Read your brochure carefully
to find if your plan has a PPO plan and who the PPO is. PPO
providers located near you can be looked up online (see the
following question for web addresses). Make sure the provider
is still a member of the PPO at the time of treatment as they
may change PPO contracts at times. Heritage cannot be responsible
for or accept liability for charges by a doctor who terminates
his contract with a PPO. |
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| Where do I find a list of medical Providers
in my PPO? |
| If your plan requires you to be treated
by a Preferred Provider Organization (PPO) to receive full benefits,
the list of providers is now accessible on the Internet. Simply
access the PPO service listed below which is used by your plan.
The Student Health Insurance Brochure to which your application
was attached will indicate which PPO to use. You may also call
your Student Health Center, or you may call Heritage for the
name of your PPO. If your Brochure indicated there is no PPO
plan for your school, you may use any licensed provider of your
choice. |
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| PPO Websites |
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| Beech
Street/CappCare |
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| Medica SelectCare |
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| What is "Pre-Certification"? |
| This simply means your provider will need
to call the PPO service or Pre-Certification service listed
on your ID Card prior to your medical treatment to determine
the medically accepted treatment protocol for your particular
condition. Please note, the pre-certification of your treatment
DOES NOT mean the claim expenses are covered, or that your claim
is a covered claim. The extent of coverage for your claim can
only be determined after a claim form has been filed which contains
all the specific circumstances pertaining to your particular
accident or illness. If you are in doubt as to whether your
condition may be covered, email us at email:
heritage Information and provide a full description of your
condition and its onset date. We will attempt to reply with
some indication for you. |
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| Is a Pre-Certification required before I
get treatment? |
| Few of our plans require Pre-Certification,
but you will want to refer to your Brochure for reference to
Pre-Cert. requirements. |
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| Is Pre-Certification required for Out-Patient
Surgery, even if my plan required Pre-Certification? |
| No, there is never a need for Pre-Cert. on Out-Patient surgery. |
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| What address do I mail my bills and /or claim
forms to? |
| There are several addresses for claim submission
as a result of the different plans and states in which we operate.
As a result, mail your bills and claim forms to the address
at the top of the claim form. To be certain you have the right
claim form and the correct address, be sure to download the
correct form for your school at the claim
form page. |
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| Does my plan cover routine exams, vision
exams, or dental treatment? |
| Unless specifically included as a benefit
of your particular plan (see your Student Health Center), there
is generally no coverage for routine health exams, vision exams
or preventive medical treatment. |
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| Does my plan cover immunizations? |
| Unless specifically included as a benefit
of your particular plan (see your Student Health Center), there
is generally no coverage for immunizations of any type. |
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| I am travelling out of the country and will
need travel immunizations, are they covered? |
| Unless specifically included as a benefit
of your particular plan (see your Student Health Center), there
is generally no coverage for immunizations of any type. |
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| How do I file a claim for Prescription drug
reimbursement? |
| Heritage does not pay the Pharmacy or drug
store directly for prescription drug expenses. If your plan
provides prescription drug benefits, you must first purchase
the drugs, then file for reimbursement. When you have incurred
covered prescription drug expenses, download the correct claim
form for your school from this Website, print it, complete and
sign it, and mail it to the address at the top of the claim
form along with a copy of the receipt for your prescription
drug purchase. |
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