The Hold Harmless provision in the Health Benefit Plans protects beneficiaries from having to pay amounts in excess of the Funds’ fee schedule and for services that are not medically necessary. Beneficiaries are responsible for co-payments and non-covered services.
Balance Bills
If a beneficiary receives a bill from a medical provider, for covered services, after the Funds have made payment the beneficiary should contact the Funds’ Call Center for assistance. A beneficiary should not pay a provider more than the normal co-payment for office and inpatient physician visits, unless advised to do so by the Funds. Beneficiaries are responsible for charges associated with non-covered services.
Collection Notices
If a beneficiary receives a notice from a collection agency, the beneficiary should contact the Funds’ Call Center immediately. The Funds will review the claims and advise the collection agency in writing that the beneficiary is not responsible for anything other than co-payments for all covered services. A beneficiary should not pay a provider more than the normal co-payment for office and inpatient physician visits, unless advised to do so by the Funds. Beneficiaries are responsible for charges associated with non-covered services.
Credit Report Problems
If a beneficiary receives a credit denial and learns that there are medical bills on the report, the beneficiary should send a copy of the credit report to the Funds’ Call Center with the entries in question circled. If the reason the beneficiary was denied credit was due to medical charges denied by the Funds for excessive fees or medical necessity, the Funds will explain this to the loan officer.
Court Summons
If a beneficiary receives a court summons for medical charges denied by the Funds, the beneficiary should contact the Funds’ Call Center immediately and mail a copy of the warrant to the Call Center. The Funds will provide legal defense on behalf of the beneficiary if the summons is for amounts related to covered medical services and those amounts are in excess of the Funds fee schedule or the amounts are for services determined to be medically unnecessary.
The Funds Call Center address is:
The Funds Call Center
P.O. Box 2320
Beckley, WV 25802
Telephone number: 1-800-291-1425
E-mail to: health@umwafunds.org
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