GrouProtector^SM Claim FAQ's

If a claim occurs, when should it be filed?

Written proof (completed claim form and supporting documentation) of the loss should be mailed within 90 days of the incident.

What is needed to file a claim?

• A fully completed claim form
• Itemized bills
• Primary insurance carrier Explanation of Benefits (if applicable)
• Proof of payment of itemized bills

Should a claim form be completed for each bill?

Only one completed claim form is required per incident. Any subsequent documents must clearly identify the plan sponsor, policy number and patient's name.

How should the claim form be completed?

All questions must be answered in full for claim to be processed. In addition:

• The Organization Certification section must be completed and certified by an official of the plan sponsor (proof of membership or certificate of coverage may be submitted in place of plan sponsor's signature, if applicable). The official cannot be the agent, broker or anyone related to the patient. Policy number must be included.
  
  
• The insured information must be completed by the patient (or parent if insured is a minor). For Excess plans, all claims must be filed with the primary insurance carrier first. Any remaining charges will be considered after payment has been made and an Explanation of Benefits has been submitted. If no other insurance exists, a written statement from the patient or parent's employer(s) must be obtained, verifying that no other coverage exists.

Assignment of benefits is optional. The signature of the patient (or parent, if patient is a minor) is required if payment is requested to be made directly to the provider or medical services. If assignment is not made, the provider may have assignment on file. In this case, proof of payment in full is required before reimbursement can be made to the patient or parent.

How should a claim be submitted?

Submit the claim by either mail or by fax.

Mail
Nationwide Specialty Health
PO Box 420
Springfield, MA 01101

Fax
1-413-214-7661

How can the status of a claim be checked?

To check the status of a claim, contact the claims department.

Call
1-800-525-8669

If all representatives are busy, please leave a detailed message including:

• Insured’s name
• Phone number with area code
• Patient name (if different from insured)
• Member number (if applicable)

Your call will be returned in the order it was received.