How are claims paid?
In the majority of situations, after you receive a medical service, your provider directly submits a claim to us for payment. Once we receive this claim, we process it, pay for covered services, and send you an Explanation of Benefits (EOB) form.
The EOB will show the date you received the service, the amount we paid, any coinsurance or deductible amounts, and any amount you are responsible for paying to the provider.
In the meantime, you shouldn’t be surprised if you receive a bill from your provider. Providers will often send you a copy of the claim they sent to us for payment.
How long does it take to pay my bills?
The processing time will depend on a number of factors. Some providers file claims every day, while others submit them once a week or even once a month. On our end, some claims are delayed because we need additional information or clarification from a provider. However, most are processed and paid immediately.
If you do not receive an Explanation of Benefits form from us within 90 days, call our Customer Service Department at (800) 279-4000 for assistance.
What if a provider asks me to pay up front?
If a provider asks you to pay for his or her services directly, be very cautious. Providers who ask patients to pay up front often do so because they know that insurance companies do not cover the services they provide. If you contact us, we can inform you if the services are covered.
If you decide to receive the service and pay the provider up front, you will need to send a copy of the bill and proof that you paid to:
WEA Trust
P.O. Box 8220
Madison, WI 53708
If the services are covered by your policy, we will provide reimbursement, less any applicable deductible, coinsurance, copayment, and reasonable and customary fee limits. |
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