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. After you visit a doctor, they will send a claim to us after they treat you.

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 (unless your deductible is $0) and toward your annual out-of-pocket maximum. You can view all this in your phone too. Discover all our mobile tools.

The claims process works a little differently depending on what type of plan you have:

Medicare Advantage

  • With this plan, your healthcare services are paid by Medicare Advantage instead of Medicare.
  • Bring your Medicare Advantage card to medical appointments and network pharmacies. Because you have all of your medical coverage in one plan, you have the convenience of only one card to bring.
  • Your healthcare providers will file claims and be paid by Medicare Advantage.

Plan 65

This plan is a supplement to Original Medicare. Original Medicare pays its share first, then Plan 65 pays some or all of the remaining costs depending on the plan you choose.Bring your Original Medicare card and your Plan 65 card for medical services. You may need a separate card for Part D outpatient drugs. Your doctors will file claims that go to Medicare first, then to Blue Cross, which pays your Medicare cost-sharing according to your Plan 65 benefits.

Medicare Secondary Payer

It is important that you let us know if you have any other health insurance in addition to Medicare Advantage. We need this information in order to determine which insurance is responsible for paying your claims first. When Medicare is not responsible for paying claims first, this is called “Medicare Secondary Payer.” When you first enroll in Medicare Advantage, we ask you to fill out a survey about your medical coverage. You can learn more about Medicare Secondary Payer on the Centers for Medicare & Medicaid (CMS) website.

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Call the Medicare Concierge team at (401) 277-2958 or 1-800-267-0439 (TTY: 711). Hours: Monday through Friday, 8:00 a.m. to 8:00 p.m.; Saturday, 8:00 a.m. to noon. (Open seven days a week, 8:00 a.m. to 8:00 p.m., October 1 - March 31.) You can use our automated answering system outside of these hours.

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Contact the Medicare Sales team at 1-800-505-BLUE (2583) (TTY: 711). Hours: Monday through Friday, 8:00 a.m. to 8:00 p.m. (Open seven days a week, 8:00 a.m. to 8:00 p.m., October 1 – March 31.) You can use our automated answering system outside of these hours.

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