For example, your plan includes prescription drug coverage, but the exact medication you’re trying to claim isn’t on the formulary your plan follows.
You may have maxed out your coverage for the year. For example, you’re trying to make a claim for a chiropractor visit. Your Freedom to Choose TM health and dental insurance Guaranteed plus plan includes $350/year for chiropractic care, but you may have already maxed out this coverage by claiming several sessions already this year or reaching the per-visit maximum amount.
FYI: Sometimes, a claim isn’t denied. It’s just pending because we need more information. If that’s the case, we’ll reach out to you or your provider directly.
We’re sorry about that! We aim for a 5-day turnaround for most claims, whether you’ve got workplace benefits or private coverage with Freedom to Choose health and dental insurance.
If it’s a simple claim, it often gets processed and paid out (if applicable) in a few days.
There are a few things that could slow us down. We could be missing information from you, like your member ID or plan number on the form. We’ll reach out to you if we have questions.
For more complicated claims we may need to reach out to the provider to get more details from them. Your claim might be delayed because this can take time.
There are a few reasons why this could happen. You might have maxed out your coverage. Your dentist might charge more than the amount in the standard fee guide. You could also have a co-payment.
Here’s how it works with our private health insurance. If you have the Freedom to Choose health and dental Select plan, it covers 70% of routine dental services, up to $350 per person per calendar year. This means that you “co-pay” the remaining 30%.
Contact us for Freedom to Choose health and dental claims.
Contact us for workplace insurance claims.