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A claim is a bill your doctor and other health care providers send to a health insurance company for payment after they have treated you. In most cases, your provider’s office will submit the claim so you don’t have to worry about it. Still, there are times when you may have to submit a claim yourself. For example, if you choose to get care from a provider who's not in your plan's network.
If you need to submit a claim:
There are a couple ways you can check the status of your claim:
Please note the claim will not show up in Blue Access for Members until it is processed. There are five types of claims statuses that you may see:
Once we process your claim, you will receive an EOB, either by email notification directing you to BAM or mail. This document will break down:
If your claim was not paid, you can file an appeal. The appeals information is included with your EOB.
Originally published 2/10/2015; Revised 2022, 2024
Hi Salvador, If you'd like to send us a private message I can have my team take a look at what's going on. ~ Kayla
We visited the Drs offive today we went to walgreens to fill the rx but they told me one medicine was not covered. How do i claim this item? Or are not elegible?
Hi Shani, If you'd like to send us a private message with your plan ID and contact information I can have my team give you a call to answer these questions. ~ Kayla