We know that Insurance claims can be a headache to deal with. Long hold times, multiple billing offices, and lack of clarity can make dealing with insurance companies a very stressful event! Luckily, our clients at Senior Benefit Services can always call us to help them file their claims. It’s as simple as calling our office and asking to speak with our Claims Department!

We asked one of our claims specialists, Joselyn Staley, for her 5 most common tips and tricks:

Hospital Indemnity (HIP) Claims: 

Items they will need to process your claims include:

  • A UB04 Form from the hospital’s billing department for your inpatient, outpatient, or observation stay at the hospital. 
  • HIP plans from Guarantee Trust Life also require the member to fill out a claim form if they are filing a claim within two years of their anniversary date. Contact our office for the claim form.
  • If the member’s plan has an ambulance rider, the insurance company will need an “itemized bill” from the ambulance company as well.

Dual Medicare Advantage Plans:

Dual eligible members should only show their: MA Plan ID card and Medicaid ID card at the doctor’s office or hospital.

IMPORTANT: Do not show your Red, White, and Blue Original Medicare ID card to the doctor’s office or hospital if you have a Dual Eligible Medicare Advantage plan.

Original Medicare Deductible:

The 2021 Part B deductible is $203. 

  • Members with MediGap Plans other than Plan C and Plan F are responsible to pay this before Medicare and MediGap will start paying on their claims. Usually you will get a bill at the beginning of the year. 
  • You can always contact Joselyn to make sure the bill was applied to your deductible.

Cancer Claims:

Insurance companies will need members to fill out claim forms as well as get a pathology report to send along with the claim form.

Prescription Drug Claims:

Insurance companies will need pharmacy print outs from the pharmacy with the member’s:

  • Personal information 
  • Date purchased 
  • Name of prescription 
  • Cost of prescription

The prescription TABS that are stapled to your bag are the best! They have all the info the insurance company needs.

Remember that you don’t need to go through the claims process alone. SBS is here to ensure you receive all the benefits available to you because when it comes down to it, we work for YOU, not the insurance companies.  

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