Claim Services

Rigby Group Benefits makes resolving our clients claim problems one of our top priorities.

We know how valuable your time is and how frustrating it can be to deal with insurance companies and/or providers when you are trying to resolve a claim problem.

Don't put yourself through the aggravation of trying to get through to the insurance company or provider to resolve your claim problem - let us handle it.  We will initiate the resolution of the problem, keep you informed of the resolution progress, and notify you when the claim issue has been resolved.

Let us handle your claim problem. Simply:

1. Download the Claim Resolution Form.
2. Complete the form.
3. Attach your bill and any other pertinent information.
4. Fax it to us at 630-236-7301.

As soon as we receive your Claim Resolution Form, we will contact the insurance company and/or provider and get to work on resolving your claim.

Also, check out the "How To Avoid Claim Problems" section below. You can eliminate some potential claim problems by following these simple guidelines.

How to Avoid Claims Problems

1.  Even when a doctor is in the directory or says they are in the network — verify by calling your health insurance company. Here are the phone numbers of some of the major carriers:

• Aetna - 800-444-6066
• American Medical Security - 800-232-5432
• Blue Cross/Blue Shield (HMO) - 800-892-2803
• Blue Cross/Blue Shield (PPO) - 800-541-2768
• CCN - 888-685-7774
• Destiny-888-999-4957
• Humana - 800-558-4444
• Trustmark-800-285-7911
• United Healthcare-800-323-4817

2.  If your doctor sends you to another doctor or facility for tests, verify that the doctor or facility is in your network.

3.  If you are going for therapy (physical, occupational, speech, chiropractic, etc.), keep your insurance company apprised of your treatment schedule (the number of times you are going, etc.). These services are covered on a medically necessary basis with the insurance company determining the medical necessity.

4.  Wait until you receive your Explanation of Benefits (EOB) explaining what the insurance company has paid before you pay a hospital or doctor bill (keep in mind that you are responsible for your co-pay). Do not pay the bill and expect to be reimbursed right away — it's much easier for Rigby Group Benefits to get your insurance company to pay the bill than it is for us to obtain a reimbursement from either the provider or your insurance company.

5.  If your doctor decides to have an X-ray or lab work (particularly blood work) done in the doctor's office, ask if the charges will be billed through their office or a third party (such as Smith Kline Beecham). Be advised that the third party may not be in your network and, therefore, the charges may be applied towards your deductible.

6.  Keep in mind that office visit co-pays usually do not count towards your deductible.

7.  Sometimes your insurance company has to verify Coordination of Benefits (COB) before paying a claim, if you are covered under another insurance plan then our insurance carrier will need to call the other insurance company to verify the other coverage. Be sure to give your doctor or hospital the employer name, group number, and name, address, and phone number of the other insurance company. This considerably speeds up the payment of your claim.

Remember, the biggest problem occurs when people see doctors they think are in their network, but aren't. We can't stress enough — call your insurance company to verify whether or not a doctor is in your network.