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Claims Process
In the U.S., it is generally recommended to seek medical treatment from in-network healthcare facilities to enjoy the convenience of direct in-network claims processing. If out-of-network care is necessary, however, you can apply for advance payment claims. Here’s a deeper dive into both direct payment claims processing and advance payment claims.
Method 1: Direct Claims Processing
After the insured individual receives treatment at a healthcare facility within the purchased plan's medical network, the clinic will submit the bill to the insurance company for direct claims processing: eliminating the need for additional claims applications.
Click the link to find in-network
Providers
Click the link to find in-network Providers
“In-network” healthcare facilities refer to doctors, clinics, health centers, hospitals, etc. that collaborate with the insurance company. For insured individuals, using insurance at in-network healthcare providers is typically more cost-effective given lower out-of-pocket expenses and higher insurance reimbursement rates. If you would like to learn more about the specific coverage details for your policy, please review accordingly.
The Claims Department starts
processing your claim
The Claims Department starts processing your claim
Claim processing typically takes around 20 days. If you wish to inquire about the status of your claim, please contact the claims department directly rather than general customer service for privacy protection purposes.
- Claim Department Service Phone:
- (800)-483-6192
- （9am - 8pm）
- Claim Department Email Address:
- [email protected]
You’ll need to provide the following information for verification purposes in your email: First name, last name, date of birth, and member ID (Aetna # starting with 52, located on your insurance card).
* Please use English when contacting the claims department*
Claims processing is complete
After the insurance company completes claims processing, they will send an Explanation of Benefits (EOB) to both the healthcare facility and the insured individual: explaining insurance reimbursement details and disbursing claimed expenses to the healthcare facility where the insured individual received treatment.
In very rare cases when claims materials are incomplete, the claims department may send an EOB requesting additional information. Claims processing will then proceed after the insured individual, healthcare facility, and/or both parties provide the requested information. So long as the additional information is submitted within one year after the date of service, the claim can be fully processed.
The bill is paid
After the insured individual receives treatment at an in-network healthcare facility, the clinic will submit the bill directly to the insurance company for direct claims processing: eliminating the need for additional claims applications.
Method 2：Advance Payment Claims
If you cannot or choose not to receive treatment at an in-network medical facility, however, you must pay all medical expenses yourself and then submit a claims application within 90 days after treatment. Please note that all medical facilities not found when searching in-network clinics are considered out-of-network.
Prepare the necessary claims
materials
Prepare the necessary claims materials
1.Claim Form
2.Itemized Bill
3.Payment Proof
4.Identity Proof
- For Medical / Sickness
- Download Claim Form
- For Prescription
- Download Claim Form
An itemized bill can only be provided by the medical facility where you received treatment when you need to file a claim for reimbursement. This document helps the claims department understand the specific details of the treatment, costs, and clinic information necessary to process your claim.
An effective itemized bill should include four key elements：
- 1.
Provider’s Name and Address
- 2.
Tax ID
- 3.
Diagnosis Code
- 4.
Procedure Code
Proof of payment can be in the form of a payment receipt, a bank statement showing the transaction, or a screenshot of the transaction details.
Documents to prove legal status in the United States can include:
International Students with F1 Visa:I-20, Passport Page, Visa Page, Class Schedule
OPT Status:EAD Card, Passport Page, Visa Page
H1B Status:H1B Approval Documents, Passport Page, Visa Page
Submit the claims application
Please submit the necessary claims application materials via email and double-check that all information is complete and accurate, as missing or incorrect information can result in processing delays.
- Email address:
- [email protected]
- Subject:
- File a Claim
- Please provide the following information in the email:
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First Name, Last Name,
Date of Birth,
Member ID
* Please use English when contacting the claims department*
The Claims Department starts
processing your claim
The Claims Department starts processing your claim
Claim processing typically takes around 20 days. If you wish to inquire about the status of your claim, please contact the claims department directly rather than general customer service for privacy protection purposes.
- Claim Department Service Phone:
- (800)-483-6192
- （9am - 8pm）
- Claim Department Email Address:
- [email protected]
You’ll need to provide the following information for verification purposes in your email: First name, last name, date of birth, and member ID (Aetna # starting with 52, located on your insurance card).
* Please use English when contacting the claims department*
Claims processing is complete
After the insurance company completes claims processing, they will send an Explanation of Benefits (EOB) to both the healthcare facility and the insured individual: explaining insurance reimbursement details and disbursing claimed expenses to the healthcare facility where the insured individual received treatment.
In very rare cases when claims materials are incomplete, the claims department may send an EOB requesting additional information. Claims processing will then proceed after the insured individual, healthcare facility, and/or both parties provide the requested information. So long as the additional information is submitted within one year after the date of service, the claim can be fully processed.
Receive reimbursement for
advance payment expenses
Receive reimbursement for advance payment expenses
The explanation of benefits (EOB) that accompanies completed claims processing will also include a reimbursement check. Please sign the back of the check and use a mobile banking app (or any other method of your choosing) to deposit it.
Need Help?
Should you have any questions, queries, or concerns about any aspect of the policy, our customer support team is available 24/7 to assist. Please do check our FAQs for fast answers to your requests.
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