What Do I Do If I Have Issues With My Claim?

Think something might be wrong with your health coverage claim? Find out what our customer advocate tells Joseph to do.

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Show Transcript

JOSEPH: Hi, my name is Joseph and today I'm meeting with a Blue Cross and Blue Shield customer advocate to talk about.....issues with my claim. I got a bill for my doctor and it doesn't look right to me. How can I check if it's correct?

BCBS ADVOCATE: This happens sometimes. The first thing you want to do is check your explanation of benefits also known as an EOB. That's a document you get from Blue Cross and Blue Shield after your claim is finalized. It breaks down each medical visit by how much your doctor has charged, what your plan covers, and how much you may owe your doctor. Carefully look it over to make sure the provider name, patient name, date of service and other details are all what you expect.

JOSEPH: What if I make a mistake?

BCBS ADVOCATE: Get in touch with Blue Cross and Blue Shield so we can review what was submitted and help answer your questions.

JOSEPH: Okay.                            

BCBS ADVOCATE: I also recommend calling your doctor's office and asking them to check the information they may need to resubmit your claim if there were errors.

JOSEPH: All right. Now what if my EOB shows my claim wasn't approved?

BCBS ADVOCATE: If you think your claim was denied in error you may be able to appeal the decision. Check your explanation of benefits or benefits booklet to learn how that works.

JOSEPH:  This is great information, thank you.

BCBS ADVOCATE: I'm glad I could help.

SPEAKER: For more information call the number on your member ID card or visit our website at BCBSOK.com