Accident / Health / Physician Claims FAQs
- How long does it take to process a claim?
If the policy has been in force for longer than two years, it is considered “Incontestable,” which means it will be paid as soon as all of the required documents are received and examined.
- Once my claim has been processed, how long will it take to receive my check?
Typically, you will receive your check within 10 - 15 business days from the time your claim was processed. If you haven’t received your check within 30 days of the date your claim was processed, please contact our Customer Service Department at:
- What is the difference between a Link to file name "UB-04" and a Link to file name "1500 Health Insurance Claim Form"?
A UB-04 is typically a summary associated with hospital stays. A 1500 Health Insurance Claim Form is normally associated with clinic or physician visits. These forms are completed by and obtained from the provider in which the treatment was sought. The form numbers can be found at the bottom of the page.
- Why do we require both a UB-04 and itemized medical billing statements with some health plan claims?
The UB-04 has information on it that is not always on the itemized medical billings or other summaries, i.e. diagnosis and procedural codes.
- Why is additional verification via medical narratives (Doctor’s Notes) requested on some accident claims?
Many times the UB-04 or 1500 Health Insurance Claim Form will include diagnosis codes; however, these codes are not always fully descriptive of why the visit to the ER or physician took place. Narratives from those visits are helpful as they go into more detail of the observations and conversations that took place during the diagnosis and treatment of the injury. You can request a copy from the treatment facility.
- Is there a time frame in which treatment must be received after an Accidental Bodily Injury?
Yes! The benefit for an accidental bodily injury is payable to an insured as long as the treatment is received as defined by your policy from a qualified institution. ALWAYS REFER BACK TO YOUR POLICY FOR FURTHER INFORMATION REGARDING BENEFIT QUALIFICATIONS.