Find Answers to Frequently Asked Questions about Claims
- What is a deductible?
- A deductible is the amount of covered charges that you must pay before the plan pays benefits.
- What is an out of pocket limit?
- An out of pocket limit is the amount of covered expenses for which each covered individual must pay a portion of before the plan begins to pay covered expenses at 100% for the remainder of the policy year. For example, the plan may pay 80% of the first $10,000.00 in covered expenses. This means that you pay 20%. The $2,000.00 that you pay is the out of pocket amount.
- How do I file a claim?
If you visit a preferred provider, your provider will file the claim on your behalf. It is very important that your health care provider has a copy of your current identification card to ensure that he or she files the claim properly.
If you visit non-preferred providers, they will likely require you to pay the full cash price for service at the time of your appointment. You will need to request an itemized billing to submit in this case. The claims submission address can be found on the back of your identification card.
- How do I add a new dependent?
- If you have recently changed your marital status, or adopted or given birth to a child, you should complete a new enrollment form listing all of your current dependents. There are times that supporting documentation such as a marriage certificate or birth certificate is required.
- My Explanation of Benefits shows a patient balance, but my dentist told me they would write it off. Who do I contact?
- WPAS, Inc. is not aware of agreements between you and your dentist. When benefits are processed, they are based on billed charges. Please contact your dentist, and ask him or her what your account reflects as patient balance.
- Does my plan have a dental preferred provider network?
- Most plans do not have contracts with any dental networks, and you can chose a licensed dentist of your choice.
- How do I preauthorize a hospitalization?
- The name and phone number of the utilization review organization that must be contacted prior to hospitalization is on the back of your identification card.