What is a claim?

A claim is a summary of services or supplies that your health care provider submits to your health insurance company for payment on treatment you received.

How do I see my claims?

You can see your in-network claim(s) by logging onto the Anthem website—anthem.com. For questions about out-of-network claims, call the fund office.

How do I file a claim?

Claims are electronically filed to Anthem by your medical provider and then, in-network claims are discounted and forwarded to Heartland Health and Wellness fund for processing. Once processed, claims are electronically returned to Anthem to issue payment(s) to the provider. You will be mailed an Explantion of Benefits (EOB), and the entire process typically takes four to six weeks. To file for an out-of-network claim, contact the Fund office.

Who do I make a payment to when I get a medical bill?

You pay your healthcare provider. NOT YOUR HEALTH INSURANCE COMPANY.

Generally, you will receive an Explanation of Benefits (EOB) from Heartland Health & Wellness Fund, and a bill from the healthcare provider/facility. The EOB is NOT A BILL. It’s just a document that shows you the breakdown of how your medical bill was processed and paid, and what you owe the healthcare provider (see “Patient’s Amount” column). The bill that you receive from the healthcare provider tells you how much you owe and to whom to make payment.

If I have health insurance, why do I still have to pay a portion of the medical bill?

It largely depends on the type of health insurance coverage you have. Refer to your Schedule of Benefits or call the fund office at 800.433.1204 for the coverage breakdown. The breakdown shows you what percentage of a particular service is covered by your health insurance plan and what percentage you are responsible for paying.

In-network vs. Out-of-network: What you should know ?

IN-network providers are contracted with the provider network (Anthem) to provide services to plan participants for specific pre-negotiated rates.

Out-of-network providers are NOT contracted with any network and don’t have pre-negotiated rates.

Typically, if you visit a physician or other provider WITHIN the network, you PAY LESS (on the amount you are responsible for paying) than if you go to an out-of-network provider. Meaning, you either have to pay more or pay the whole bill for services you receive from out-of-network providers.

When a provider is in the health insurance company’s network, it means that the provider has agreed to provide medical services to the plan participants, and their dependents at prices to which the provider and the health insurance company agreed.

The in-network provider generally provides a covered benefit at a lower cost to the health insurance company and the Plan Participants, than to someone without insurance, or someone with insurance through an out-of-network provider.


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