HOW TO FILE A CLAIM. IMPORTANT: The submission of a Claim does not automatically mean that the damage to or breakdown of the Product is covered under Your Plan(s) and this Agreement. In order for a claim to be considered, You have to contact the Administrator first for Claim approval and authorization number.
HOW TO FILE A CLAIM. Network dentists file claims on your behalf. Non-network dentists may or may not file claims on your behalf. If a non-network dentist does not file a claim on your behalf, you will need to file it yourself. To file a claim, please send us the dentist’s itemized bill, and include the following information: • your name; • your member ID number; • the name, address, and telephone number of the dentist who performed the service; • date and description of the service; and • charge for that service. Please send your claim to the address listed in the Contact Information section. Claims must be filed within one calendar year of the date you receive a covered dental service. Claims submitted after this deadline are not eligible for reimbursement. This timeframe does not apply if you are legally incapacitated.
HOW TO FILE A CLAIM. If You need to file a Claim under this Service Contract, You must obtain authorization by calling the Administrator at 1-800-228- 2731 or by visiting xxx.XxXxxxxxxxxxXxxx000.xxx/XxxxxxXxxx. If authorization is needed when the Administrator’s office is closed, You may obtain prior authorization by visiting xxx.XxXxxxxxxxxxXxxx000.xxx/XxxxxxXxxx at any time. Failure to obtain prior authorization may result in non-payment. EXCLUSIONS – We shall not provide coverage only for those specifically listed items in the “EXCLUSIONS (WHAT IS NOT COVERED)” section which occurred while owned by You. GUARANTY is amended to include: A contract holder is entitled to apply directly to Wesco Insurance Company, at 00 Xxxxxx Xxxx, 00xx Xxxxx, Xxx Xxxx, XX 00000 or 000-000-0000 for refund, payment or performance due.
HOW TO FILE A CLAIM. Notice of Claim: Notice of claim must be reported to Us or Our authorized representative within twenty (20) days after a loss occurs or as soon as is reasonably possible. You or someone on Your behalf may give the notice. The notice should be given to Us or Our authorized representative and should include sufficient information to identify You. Failure by You or someone on Your behalf to make such notification may result in no benefits being paid. Claim Forms: When notice of claim is received by Us or Our authorized representative, iTravelInsured forms for filing proof of loss will be furnished. If these forms are not sent within fifteen (15) days, the proof of loss requirements can be met by You sending Us a written statement of what happened. This statement must be received within the time given for filing Proof of Loss. Proof of Loss: Proof of loss must be provided within ninety (90) days after the date of the loss or as soon as is reasonably possible. Failure to furnish such proof within provided period will not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to furnish such proof during that time. Proof of Loss must, however, be furnished no later than twelve (12) months from the time it is otherwise required, except in the absence of legal capacity. Where to Report a Claim: IMG iTravelInsured Claims
HOW TO FILE A CLAIM. You must contact the Administrator for authorized service within thirty (30) days of noticing the defect or damage to Your Covered Product. Failure to contact the Administrator within thirty (30) days of noticing the defect or damage may result in claim denial. Call Us toll-free at 000-000-0000 between the hours of 8:00 AM and 5:00 PM Eastern Time Monday-Friday, or go online to xxx.0xxxxxxx.xxx. Prior to Our dispatching service to Your location, We may request that You provide Us with pictures of Your defective or damaged Covered Product. All repairs must be authorized by the Administrator prior to performance of work. Claims on unauthorized repairs may be denied. You may be asked for a credit card number before We dispatch service to Your location. If You refuse service on a Covered Product after We have dispatched the repair servicer to Your location, You will be billed for that servicer’s applicable trip charge. You agree that We or the Administrator may share with the servicer information about You and Your Covered Product, including, without limitation, Your name, phone number(s), address, email address and the products You purchased from the Selling Retailer. In-Home Service will be performed in Your home whenever possible, provided that the servicer may opt to remove Your Covered Product to perform service in-shop and will return the Covered Product upon completion. If You are not within one of the Administrator’s authorized service areas, You may request termination and refund of the Service Contract sales price subject to the cancellation provision in this Service Contract. If You choose, the Administrator will provide service at the nearest service location and You must provide the necessary deliveries and pickups at Your expense. Service is available during the regular business hours of the servicer. We do not guarantee days or time of service. We will not be liable for any damages arising out of delays, either before or after a day or time of service is agreed upon. You must make the Covered Product reasonably accessible to the repair person. If the Covered Product is not accessible, We may decline to provide service or assess You an additional charge, proportionate with the difficulty in working on the Covered Product. Except for delivery damage, if We remove the Covered Product for in-shop repairs and then determine that replacement is required, and You refuse delivery of Your replacement item, You will be reimbursed the purchase price of thi...
HOW TO FILE A CLAIM. When you receive care from your Primary Care Physician or from another Pro vider who is affiliated with your Participating IPA/Participating Medical Group, or from your Woman's Principal Health Care Provider, a Claim for benefits does not have to be filed with the Plan. All you have to do is show your Plan ID card to your Provider. However, to receive benefits for care from another Physician or Provider, you must be referred to that Provider by your Primary Care Physician or Woman's Principal Health Care Provider. When you receive care from Providers outside of your Participating IPA/Partici pating Medical Group (i.e. emergency care, medical supplies), usually all you have to do to receive your benefits under this Certificate is to, again, show your Plan ID card to the Provider. Any Claim filing required will be done by the Pro vider. There may be situations when you have to file a Claim yourself (for example, if a Provider will not file one for you). To do so, send the following to the Plan:
HOW TO FILE A CLAIM. You must see a Network Physician in order to obtain Benefits. Except for Emergency Health Care Services and situations where specific Covered Health Care Services are not available from a Network provider, Benefits are not available for Covered Health Care Services provided by out-of-network providers. If services are not available from a Network provider, you must follow the instructions found under Health Care Services from Out-of-Network. Should you decide to seek services from an Out-of-Network provider, you are entitled to a good-faith estimate of the total cost(s). We adjudicate claims consistent with industry standards. We develop our reimbursement policy guidelines generally in accordance with one or more of the following methodologies: • As shown in the most recent edition of the Current Procedural Terminology (CPT), a publication of the American Medical Association, and/or the Centers for Medicare and Medicaid Services (CMS). • As reported by generally recognized professionals or publications. • As used for Medicare. • As determined by medical staff and outside medical consultants pursuant to other appropriate sources or determinations that we accept. Following evaluation and validation of certain provider xxxxxxxx (e.g., error, abuse and fraud reviews), our reimbursement policies are applied to provider xxxxxxxx. We share our reimbursement policies with Physicians and other providers in our Network through our provider website. Network Physicians and providers may not bill you for the difference between their contract rate (as may be modified by our reimbursement policies) and the billed charge. However, out-of-Network providers may bill you for any amounts we do not pay, including amounts that are denied because one of our reimbursement policies does not reimburse (in whole or in part) for the service billed. You may get copies of our reimbursement policies for yourself or to share with your out-of-Network Physician or provider at the telephone number on your ID card. We may apply a reimbursement methodology established by OptumInsight and/or a third party vendor, which is based on CMS coding principles, to determine appropriate reimbursement levels for Emergency Health Care Services. The methodology is usually based on elements reflecting the patient complexity, direct costs, and indirect costs of an Emergency Health Care Service. If the methodology(ies) currently in use become no longer available, we will use a comparable methodology(ies). We...
HOW TO FILE A CLAIM. Call the toll-free ProtectALL number at [0-000-000-0000] or go online [xxx.xxxxxxxxxxxx.xxx/xxxxxxxxxxxxx] with Your Sales Receipt/Invoice readily available. Stain or Damage to covered Product must be reported within thirty (30) days of discovery to the Administrator. We will ask you to describe the problem Your Product is experiencing and provide any additional information or documentation by the Administrator to validate Your Claim. After confirmation of Your Claim eligibility under this Protection Agreement, We will attempt to troubleshoot the problem You are experiencing. If we are unable to resolve the problem, We will service Your Covered Product as described under the Coverage section listed above. THIS PROTECTION AGREEMENT DOES NOT REPLACE THE MANUFACTURER’S WARRANTY. If You refuse service on a Covered Product after We have confirmed a repair date and time with You and dispatched the repair servicer to Your location, You will be billed for that servicer’s applicable trip charge. IMPORTANT: The submission of a Claim does not automatically mean that the damage or breakdown of the Product is covered under this Protection Agreement. For a Claim to be considered, You must contact the Administrator for Claim approval and authorization number (if any).
HOW TO FILE A CLAIM. If You need to file a Claim under this Service Contract, You must obtain authorization by calling the Administrator at 0-000-000-0000 or by visiting xxx.XxXxxxxxxxxxXxxx000.
HOW TO FILE A CLAIM. 1. To arrange for service under this CONTRACT, YOU must first call 000-000-0000 to obtain prior authorization.
2. You may not seek service from any other vendor, or receive any provision of service under this agreement, without prior approval.
