In most cases, when you go to a network provider, you will not need to submit a claim for your care — their office will do it for you using the information on your member ID card. However, there are a few occasions when submitting a claim on your own may be required for you or the provider to receive reimbursement:
- Overseas Claims: For covered services received outside the United States and Puerto Rico, you must submit a completed overseas claim form.
- Out-of-Network Claims: Out-of-network providers may not submit a claim on your behalf, and you may have to submit this claim on your own.
- Multiple Claims Payers: If another health plan is your primary payer and does not automatically submit claims to your secondary payer, you will need to submit a claim. If you have Medicare primary coverage, Medicare generally sends the processed claim for secondary coverage consideration.