|
Members > Frequently Asked Questions
Whom should I call if I have questions?
Is my provider in the network? / How can I find a provider?
What procedures need to be pre-certified?
Is a procedure covered as long as it has been pre-certified?
Is a procedure automatically covered if a CHP provider prescribes it?
What do I do if a CHP or First Health (formerly CCN) provider sends me a bill for the amount that your TPA does not cover?
What do I do if my provider will not accept my co-pay for the office visit or prescription drugs?
How can I get my provider on the CHP list?
How can I maximize my benefits?
If applicable, does our plan have a dental provider network?
I have not received a response to my claim. What should I do?
Q: Whom should I call if I have questions?
A: For questions regarding Claims, Eligibility, Benefits, or Pre-Certification, please click here.
For other questions, please contact CHP directly.
^ Back to top
Q: Is my provider in the network? / How can I find a provider?
A:
Please visit our Find a Doctor page to check to see if your doctor is in the CHP network, or to find a provider in the specialty you need.
^ Back to top
Q: What procedures need to be pre-certified?
A: This can differ from plan to plan. Please contact your human resources or personnel department for specifics on your plan.
^ Back to top
Q: Is a procedure covered as long as it has been pre-certified?
A: No. Just because a procedure has been pre-certified, it does not authorize coverage. If you have questions about whether something is covered, first read your benefit booklet and if the booklet is unclear, please call the claims analyst at your TPA (your human resources manager can put you in touch with the TPA).
^ Back to top
Q: Is a procedure automatically covered if a CHP provider prescribes it?
A: No. Just because a CHP provider prescribed the service (or performed the service) does not automatically qualify it for coverage.
^ Back to top
Q: What do I do if a CHP or First Health (formerly CCN) provider sends me a bill for the amount that your TPA does not cover?
A: CHP and First Health (formerly CCN) providers have agreed to accept a negotiated amount for their services. They are not supposed to send you a bill for any amounts above this negotiated amount. If they do, please contact CHP directly.
^ Back to top
Q: What do I do if my provider will not accept my co-pay for the office visit or prescription drugs?
A: If your plan has an office visit co-pay or aprescription co-pay provision and your provider is a CHP, First Health (formerly CCN), ProVantage network provider, or PCN provider, they must by contract accept the applicable co-pay. If they do not, or if they make you pay the full amount up front, please contact CHP directly. You may also want to call the PPO Info Line on your ID card.
^ Back to top
Q: How can I get my provider on the CHP list?
A: Have the provider contact the CHP office for information at (831) 657-1600, or contact CHP directly and if possible we will try to contact the provider.
^ Back to top
Q: How can I maximize my benefits?
A: Whenever possible, you should use PPO providers. If you are receiving care outside of this area, call the PPO Info Line on the back of your ID card for the nearest First Health (formerly CCN) provider.
^ Back to top
Q: If applicable, does our plan have a dental provider network?
A: No. If your plan provides for dental coverage, you may use any dentist and still receive maximum benefits. (Please make sure your plan provides dental coverage).
^ Back to top
Q: I have not received a response to my claim. What should I do?
A:
You should allow 20 business days (4 weeks) to receive a response to your claim.
-
If you personally mailed the claim to your TPA, please contact your claims analyst to determine if they have received your claim and are having problems processing it. If they have not received it, please re-submit your claim.
-
If your provider's office was supposed to mail the claim, please contact the provider's office and ask them when they mailed it to your TPA. We suggest you also double-check the address your provider used.
^ Back to top
|
