Filing Claims

Filing claims in the United States

If you visit a doctor outside the network or before your enrollment has been processed, you may need to pay the full amount due, then file your own claim to receive reimbursement for the portion covered by your benefits. To file a claim:

• Complete the appropriate claim form found on our downloads page.
• Make a copy of the completed form and send it, along with any additional information available (e.g., copies of bills or receipts, doctor’s notes), to the address listed on the claim form. For medical claims, we recommend calling Highmark Blue Cross Blue Shield to acquire a case manager and faxing it to that individual.
• Allow four weeks for processing. If no response is received, contact the appropriate insurance company to find out the status of the claim.
• If you are unable to resolve the claim with the insurance company yourself, Covenant Benefits will act as your liaison to ensure that eligible claims are paid in a timely manner.
• Life and long-term disability claims: Claims should be filed within 90 days, if possible. Contact Covenant Benefits for instructions.  
• Medical, prescription, dental, or vision claims: Claims must be filed within 12 months of the date of service. 

Filing claims outside of the United States

When overseas, in-network doctors are very scarce. When receiving medical attention or filling prescriptions, you will most likely be required to pay the balance upfront and request reimbursement for the covered portion by filing a claim after the date of service. Send claims as soon as possible after the date of service to avoid delays and complications in the approval/reimbursement process. When filing a claim, the following information must be provided:

• The appropriate completed claim form found on our downloads page
• Details of what happened on the date of service (not necessary for Express Scripts prescription claims)
• Your bill or a letter from the doctor explaining the appointment with a detailed description of the amount owed
• An English translation of your bill and/or letter from your doctor
• The exchange rate to US dollars