What you need to know about claims

Insurance companies always talk about claims. If you ding your car, the repair shop will submit a claim to your auto insurer after they fix your car. Health insurance is similar. When you visit a doctor, they will send a claim to us after they treat you. That means most members like you never have to worry about filing a claim with us.

You can see a list of claims for your care when you log in to your online account. You also will see how much you have spent toward your deductible and toward your annual out-of-pocket maximum. You can view all this in your phone too. Discover all our mobile tools.

"This is not a bill"

When you visit a doctor, lab, or hospital and you have to pay part of the cost, we will send you a Healthcare Services Summary (HSS) in the mail. (Some insurance companies call it an Explanation of Benefits.) It shows how much your provider will charge you when they send you an actual bill—and how much you saved by using the BCBSRI network.

Use our interactive guide to understand your HSS

It’s important to compare the HSS to the bill you receive from your doctor to make sure you’re being charged the right amount. If the amounts don’t match, call your doctor or BCBSRI Customer Service at (401) 459-5000 or 1-800-639-2227 (outside RI) . We can help make sure the amounts are being calculated correctly.

For out-of-network services

Some of our plans cover out-of-network services. If you receive care from an out-of-network provider, you might have to pay them first and then file a claim with us to be reimbursed. You can learn more on page 16 of your Member Handbook. If you have any questions, we’re happy to help. Just call Customer Service at (401) 459-5000 or 1-800-639-2227 (outside RI).

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