Page 83 - Aegion PPO SPDs
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When You need Blue Cross Blue Shield Global Core claim forms You can get international claims forms in
the following ways:
Call the Blue Cross Blue Shield Global Core Service Center at the numbers above; or
Online at www.bcbsglobalcore.com.
You will find the address for mailing the claim on the form.
Unauthorized Use of Identification Card
If You permit Your Identification Card to be used by someone else or if You use the card before coverage
is in effect or after coverage has ended, You will be liable for payment of any expenses incurred resulting
from the unauthorized use. Fraudulent misuse could also result in termination of the coverage. Fraudulent
statements on enrollment forms and/or claims for services or payment involving all media (paper or
electronic) may invalidate any payment or claims for services and be grounds for voiding the Member’s
coverage. This includes fraudulent acts to obtain medical services and/or Prescription Drugs.
Questions About Coverage or Claims
If You have questions about Your coverage, contact Your Plan Administrator or the Claims Administrator’s
Member Services Department. Be sure to always give Your Member identification number.
When asking about a claim, give the following information:
identification number;
patient’s name and address;
date of service and type of service received; and
Provider name and address (Hospital or Physician).
To find out if a Hospital or Physician is a Network Provider, call them directly or call the Claims
Administrator.
The Plan does not supply You with a Hospital or Physician. In addition, neither the Plan nor the Claims
Administrator is responsible for any Injuries or damages You may suffer due to actions of any Hospital,
Physician or other person. In order to process Your claims, the Claims Administrator or the Plan
Administrator may request additional information about the medical treatment You received and/or other
group health insurance You may have. This information will be treated confidentially.
An oral explanation of Your benefits by an employee of the Claims Administrator, Plan Administrator or
Plan Sponsor is not legally binding.
Any correspondence mailed to You will be sent to Your most current address. You are responsible for
notifying the Plan Administrator or the Claims Administrator of Your new address.
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the following ways:
Call the Blue Cross Blue Shield Global Core Service Center at the numbers above; or
Online at www.bcbsglobalcore.com.
You will find the address for mailing the claim on the form.
Unauthorized Use of Identification Card
If You permit Your Identification Card to be used by someone else or if You use the card before coverage
is in effect or after coverage has ended, You will be liable for payment of any expenses incurred resulting
from the unauthorized use. Fraudulent misuse could also result in termination of the coverage. Fraudulent
statements on enrollment forms and/or claims for services or payment involving all media (paper or
electronic) may invalidate any payment or claims for services and be grounds for voiding the Member’s
coverage. This includes fraudulent acts to obtain medical services and/or Prescription Drugs.
Questions About Coverage or Claims
If You have questions about Your coverage, contact Your Plan Administrator or the Claims Administrator’s
Member Services Department. Be sure to always give Your Member identification number.
When asking about a claim, give the following information:
identification number;
patient’s name and address;
date of service and type of service received; and
Provider name and address (Hospital or Physician).
To find out if a Hospital or Physician is a Network Provider, call them directly or call the Claims
Administrator.
The Plan does not supply You with a Hospital or Physician. In addition, neither the Plan nor the Claims
Administrator is responsible for any Injuries or damages You may suffer due to actions of any Hospital,
Physician or other person. In order to process Your claims, the Claims Administrator or the Plan
Administrator may request additional information about the medical treatment You received and/or other
group health insurance You may have. This information will be treated confidentially.
An oral explanation of Your benefits by an employee of the Claims Administrator, Plan Administrator or
Plan Sponsor is not legally binding.
Any correspondence mailed to You will be sent to Your most current address. You are responsible for
notifying the Plan Administrator or the Claims Administrator of Your new address.
83
