We've got good news and bad news. The bad news is you're hurt, or else you wouldn't be here. The good news is we're here to help! In order to file a claim, there are a few things we need from you to make the process as expedient and streamlined as possible.
FYI: The documentation we need can differ depending on whether or not you had health insurance in effect at the time of treatment.
These are the documents that are required in order to file a claim, depending on whether or not you had health insurance at the time of treatment.
Explanation of Benefits (EOB):
(Necessary if you had health insurance at time of treatment)
What it is: First and foremost, an explanation of benefits is not a bill. And you will not receive one unless you had health insurance at the time of treatment! The explanation of benefits is a statement from your health insurance company with details on payment information regarding medical services you received. It explains what portion of services were paid by your insurance plan and what parts you’re responsible for paying. Your insurance company sends it to you when your health care provider submits a claim on your behalf.
How to get it: You will receive it in the mail after receiving medical care. If you don't receive it in the mail within a few weeks, you can always call your health insurance provider and ask them to send it. However, if your medical provider has not yet filed a claim for the services you received, then your insurance company will not be able to send the explanation of benefits until they do.
Why we need it: This document helps us verify your medical coverage and confirms how much you can be reimbursed for your treatments. If you had health insurance at the time of treatment along with Spot, it's important for us to determine who will cover what.
Pro Tip: It may be tempting, but don't throw away mail from your insurance provider, especially after getting injured. Though most times it may be junk, your explanation of benefits will come through via snail mail and it'd be a hassle to have to call your insurance company to ask for another.
Medical Bills:
(Necessary if you did not have health insurance at time of treatment, optional if you did have insurance at time of treatment)
What it is: A medical bill is a document that outlines the costs associated with your medical care and is sent by a provider or facility. It will include how much you owe for what services you received.
How to get it: You will receive medical bills in the mail after receiving medical care. You will likely receive multiple bills from different providers and services.
Why we need it: If you didn't have health insurance at the time of treamtnet, medical bills are the only way we can piece together the costs associated with your accident and treatments. They help us determine how and what to reimburse as part of the claims process. If you did have health insurance at the time of treatment, we can get all the information we need from the explanation of benefits statements, so medical bills aren't necessary to file a claim.
Pro Tip: You may receive multiple medical bills for even simple, straightforward injuries. For example, if you break a finger and go to the ER, you will likely receive a bill from the treating provider, the facility, radiology if you received X-Rays, and sometimes more. Make sure you save all the bills you receive related to your treatment so you can upload them to your claim!
Receipts or Proof of Payment:
(You will only have receipts or proof of payments if you paid out-of-pocket for medical care related to your claim. You may have receipts whether or not you had insurance at the time of treatment)
What it is: A document that will be accepted as proof of payment should include the date you paid the bill, the date of service on the bill, and the amount you paid. This could be from a credit card receipt as long as the above information is present.
How to get it: There are multiple ways to get a receipt, and sometimes it will depend on what you're paying for. When you make a payment in person, request that the provider or facility provides you with a receipt. If you decide to pay a bill online, you can take a screenshot in your account that shows the payment, payment date, and service date. Make sure that the screenshot includes your name or other identifying details.
Why we need it: If the service you paid for qualifies for reimbursement under your Spot policy, then you'd want it reimbursed! We need to know how much you were billed and how much you paid in order to accurately reimburse.
And at least one of the following:
HCFA 1500 (aka CMS-1500) Form:
What it is: Think of this as a medical superbill. The HCFA-1500 is the form that clinical practitioners and physicians use to submit claims for their services. It contains important information like your information, dates of service, medical codes for treatments and more.
How to get it: Request one up front when you visit a doctor after your accident. If you need to be seen multiple times, request one each time you see the doctor. Though this form is a communication tool between providers and insurance companies only, your doctor's office must provide it to you when requested.
Why we need it: It accurately outlines the services and treatments you received in a way that makes it easy for our team to verify and reimburse your claim. Instead of waiting to upload medical bills in the mail (that sometimes come months after the fact), by requesting this form each time you see the doctor, you can be assured that neither you nor our team will be hunting down missing information.
Pro Tip: It's not common practice for your doctor's office to send HCFA-1500 forms to patients unless requested. Be sure to let the office know up front you would like a copy after your visit and it'll make things easier and quicker.
UB04 Form:
What it is: This form is how institutional providers, like hospitals, bill insurance. The difference between the UB04 and the HCFA-1500 is that the UB04 form is filled out by the facility (like a hospital or physical therapy center) whereas the HCFA-1500 is filled out by the provider.
How to get it: You will need to request a UB04 from the hospital, physical therapy center, or facility in which you received treatment. If you just saw your doctor at their office, chances are you will not need a UB04 form.
Why we need it: Like the HCFA-1500 form, the UB04 form describes in detail how and for what the facility is billing your insurance. This information is vitally important to our team so that we may get you quickly and accurately reimbursed!
Pro Tip: Ask the hospital to provide a completed UB04 or ask your physician to provide a completed HCFA-1500. The two form types do not always stand alone. For example, if a surgeon performs a procedure in a facility like a hospital, a CMS-1500 will be submitted for the surgeon’s services only, while a separate UB04 form will be submitted for the use of the facility. Both forms will be needed to fully bill out for a procedure.