CP-2017-Expat-NH-Ben-Guide

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2017 EXPAT BENEFITS
GUIDE
7
FILING A CLAIM
For most medical services out-of-network, and
sometimes outside the U.S., you will have to pay
for your care and file a claim for reimbursement
(unless a direct settlement arrangement has been
set up with a participating hospital). You can submit
a claim electronically or using a paper form.
1 To submit an online claim, log on to
and click the
“Submit Claim” tab. Complete a Request for
Medical/Dental Benefits form and follow the
instructions to submit your claim electronically.
2 If you prefer to submit your claim via fax, email
or mail:
a. Copy all fully-itemized medical bills and
receipts on letter-sized paper. Be sure all
copies are legible. Bills and receipts should
include:
– Patient’s name and relationship to
employee,
– Provider name, address and telephone
number,
– Date of service,
– Amount charged,
– Procedure(s) performed, and
– Diagnosis/nature of illness (if this is
not included, you may write it on the
bill/receipt; please sign and date any
handwritten notes).
b. Write your Social Security number or
assigned identification number on each
piece of paper.
c. If faxing, include a fax coversheet with the
date, total number of faxed pages and your
contact information (phone number, fax
number and/or email address).
d. Fax, email or mail the claim form and copies
of medical bills and receipts to:
– Fax: 1-859-425-3363 (inside the U.S.) or
toll-free to 1-800-475-8751 (outside the
U.S., via AT&T + access).
– Email: .
– Mail: Standard mail or overnight express
mail to the address shown on the claim
form.