The Hold Harmless Program is part of the Funds’ Benefit Plans. It protects beneficiaries from having to pay balances on medical claims that were denied because of the Funds’ payment level or because the service was not medically necessary. Beneficiaries are responsible for payment of copayments and non-covered services.
Contact the Funds’ Call Center at 1-800-291-1425, as soon as you receive a balance bill, collection notice, credit denial or legal action. The Funds will need to review all the information that was sent to you. The Funds will review the balance and let you know if the denied amount is protected by the Hold Harmless Program or if you need to pay for a copayment or a charge for a non-covered service.
The following information will explain the different types of notices you may receive regarding a balance, and how the Funds and the Hold Harmless program will help you.
This type of notice is usually from the provider and shows the current balance amount. Most providers send this out automatically and it may be sent to you before the Funds pays the claim.
This type of notice may come from a provider, a collection agency or a law office. The notice will inform you of a balance that is owed and may tell you that the amount must be paid within a certain time period.
This type of notice may be sent to you if you applied for a loan or any other type of credit and the application was denied or you may find a medical account on a copy of a credit report that you request.
It is very important that you contact the Funds’ Call Center immediately if you receive any legal action involving a medical claim. This type of notice may be in the form of a Warrant, Summons, Proof of Claim, Notice to Appear, Estate lien, tax offset or other titles. It may be served on you in person or by mail and will identify the name of a court, the attorney’s name or provider’s name that filed the case and will list you and/or your spouse’s name as the Defendant. It may tell you that a hearing date has been set, or tell you what other action you need to take before a certain date.
No, you should not pay a provider for more than your normal copayment. Contact the Call Center if you would like the names of doctors in your area that accept the Funds’ payment levels.
You do not need to pay any denied amount except if the denial states the services are not covered by the Funds. You may also need to pay a copayment that was not paid at the visit.
The Funds and its Hold Harmless program cannot protect you or obtain a refund for you if you choose to pay the balance on a medical claim. Any balance is subject to collection, credit report referral and/or legal action. It is your decision whether you want to pay a balance or whether you want the Funds’ Hold Harmless program to protect you from paying the balance that involves fee level or medical necessity denials. The Funds cannot prevent balances from appearing on a credit report and cannot guarantee that an account will be removed from a credit report once the claim is paid, or a legal action is resolved.
The Funds is not able to prevent a balance from being referred to a credit bureau or on a credit report. Should you have a balance from a medical bill added to your credit report, you may contact the Call Center to get assistance in disputing the balance.