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How claims work

In most cases, when you receive health care, your doctor sends us a bill, also called a claim. We then review the claim to determine whether the services you received are covered by your policy, how much we will pay the doctor and how much you need to pay.

How do we figure out who pays what?

Here’s the process:

  1. You go to your health care provider to receive medical services.
  2. Your health care provider sends us a claim.
  3. We pay your provider. We determine how much of the claim to pay based on your specific coverage and discounts we’ve negotiated on your behalf. We also consider whether another insurance policy is responsible for a portion of the cost.
  4. You are responsible to pay your provider any amount that is not covered under your health insurance. Usually, this includes your deductible, coinsurance and copayments. Your provider will send you a bill to let you know what you owe.

You will receive a Personal Health Statement after we have processed your claim. The statement will include the amount your doctor billed us for your health care, how much you saved as a Security Health Plan member, how much we paid and how much you owe your health care provider.

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