FILING AN INSURANCE CLAIM
Our goal is to simplify the processing of your claims as much as possible. To assist in the timely payment of a claim, please note the following information and recommended procedures: **If the provider requests payment at the time of service, please inform the provider that this policy carries NO deductible and NO co-payment. Again, they can verify that you are covered by calling NAMB Benefits Services. DO NOT PAY FOR SERVICES UNLESS IT IS ABSOLUTELY NECESSARY** Notice of Claim: It is very important that you complete and send the “Notice of Claim” form since your claim WILL NOT be paid without it. A completed “Notice of Claim” form must be submitted to POMCO within 20 days after any accident or illness covered by the Policy. Only one form is needed for each accident or illness. You can find a copy at www.answerthecall.net. This form is DIFFERENT than the form the doctor sends to the insurance company. Verification of Coverage: If a doctor or hospital needs to verify that you are covered by NAMB’s student insurance policy, they should contact NAMB Benefits Services at (800) 472-2243. Mailing Address: POMCO PO Box 186 Syracuse, NY 13206-0186 Procedures: Example 1: You have other primary insurance coverage AND the NAMB Accident Illness Policy coverage: a. Go to any doctor or emergency room. b. Make sure you take your primary insurance cards AND your NAMB Accident Illness Policy ID card. c. Have the doctor or hospital facilities submit a claim to both your other primary insurance carrier and to POMCO d. Contact your State or Convention supervisor to complete a “Notice of Claim” form available at www.answerthecall.net, (http://www.answerthecall.net/site/c.eeIMLROpGjF/b.795395/k.7832/Resources_For_Serving.htm). e. When you (or your parent) receive an Explanation of Benefits (EOB) from your other primary insurance carrier, please mail it to POMCO f. Payment will be made directly to the doctor or hospital by POMCO Example 2: You DO NOT have other primary insurance (only the NAMB Accident Illness Policy ID card): a. Go to any doctor or emergency room. b. Make sure you take your NAMB Accident Illness Policy ID card. c. Have the doctor or hospital facilities submit a claim to POMCO d. Contact your State or Convention supervisor to complete a “Notice of Claim” form available at www.answerthecall.net, (http://www.answerthecall.net/site/c.eeIMLROpGjF/b.795395/k.7832/Resources_For_Serving.htm). e. Payment will be made directly to the doctor or hospital by POMCO Example 3: You or your supervisor DOES pay for services: a. You or your supervisor will need to send a completed claim form or itemized bill (with a receipt from the doctor or hospital) to POMCO b. Contact your State or Convention supervisor to complete a “Notice of Claim” form available at www.answerthecall.net, (http://www.answerthecall.net/site/c.eeIMLROpGjF/b.795395/k.7832/Resources_For_Serving.htm). c. Payment will be made directly to you or your supervisor by POMCO.
Filing An Insurance Claim.doc
1/11/2009