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UFCW LOCAL 1776 and
PARTICIPATING EMPLOYERS HEALTH and WELFARE FUND |
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Medical Coverage (Option B
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| How to Submit Claims All Personal Choice preferred providers, Blue Cross/Blue Shield PPO providers and any other provider which is under a contract with the Fund will file the claim for you. Simply present your insurance card. If you receive services from a non-preferred provider, you may have to file the claim yourself. Services from preferred providers When you use a preferred provider, be sure to show your identification card which bears the Independence Blue Cross Personal Choice logo. These providers will forward all bills directly to Personal Choice or the applicable Blue Cross/Blue Shield Plan. Personal Choice will determine benefits for covered services in accordance with this Plan. Payment will be made directly to the provider, indicating the provider's pre-determined fee, the amount paid by the Plan and any balance due from you. You will be responsible for the payment of any "patient owes" amount stated on the Explanation of Benefits you receive. If you have any questions regarding the claim or its calculation, you should contact the Fund office, or call the IBC/UFCW Local 1776 Dedicated Customer Service Unit at 1-800-335-9596 between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday (Eastern Time). Services from non-preferred providers When you receive a bill for medical services, send it to Personal Choice with the Personal Choice claim form. Make copies of all documents you are submitting. Bills must be complete. Each bill must be an original and should show:  Your name and social security number Date(s) of service Charge for each service Diagnosis (reason for treatment) Type(s) of charge(s) (CPT-4 code and/or
description of service(s) rendered)The following will not be acceptable: Cancelled checks Cash register receipts Balance due bills (bills that show only the
amount owed)If you need additional claim forms, contact the Fund office, or call the IBC/UFCW Local 1776 Dedicated Customer Service Unit between 8:00 a.m. and 5:00 p.m. Monday through Friday (Eastern Time) at 1-800-335-9596. All payments will be made directly to the provider unless a paid receipt/bill is received. If you have any questions, contact the Fund office, or call or write: Personal Choice Attn: IBC/UFCW Local 1776 Dedicated Customer Service Unit 1901 Market Street Philadelphia, PA 19103-1480 1-800-335-9596 |