If you did not have previous coverage, or if the break in coverage was longer than 63 days, you will be subject to the pre-existing time frame. EBMS may be able to waive some or all of the items denied for pre-existing status. This review will verify if there was a break in coverage, as well as how long you were covered under the former insurance policy. If you were seen or treated for something that is indicated in your medical records within the six-month look-back period, your current plan will not initially make payment, and will extend our investigation by reviewing any Certificates of Creditable Coverage (CCC) from previous health insurance carriers. If it is not, your plan will pay according to the coverage outlined in your Benefits Booklet. This process verifies whether what you are being seen for is considered a pre-existing condition. What that means is that when we receive a claim, we will request medical records from that provider and any other providers seen. Benefits & Participating ProvidersĪ: A pre-existing condition is a condition for which the patient was treated within a specified time period prior to becoming enrolled under the insurance plan (the look-back period). Provider Customer Service Information – includes a phone number for providers to call with questions about your benefit plan, a number to call for all inpatient pre-authorizations, and an address for claims submittal.īenefit plan ID cards may be requested through the Customer Service Center during regular business hours or through your personal account within miBenefits! Visit to access miBenefits.Customer Service Information – includes the phone number and website for all questions regarding benefits, claims and eligibility.Pharmacy Information – includes your Rx Vendor and contact phone number as well as your BIN/PCN Numbers, which allow the pharmacy to submit claims for you.Preferred Provider Organization (PPO) – logo and contact phone number to locate a preferred provider: You need to make sure your provider is contracted with the PPO to insure the highest benefit level and best rates or cost to you.
Eligibility Information – such as Policy Holder’s Name, Group Name and Number and Policy ID Number.A: Your benefit plan ID card includes information necessary to submit claims or obtain information regarding your benefits and other healthcare services:
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