Learn how we process your claims and pay your providers.
Do I pay my provider at the time of service?
Yes, you must pay your copayment when you see your in-network provider. Your copayment amount depends on the health insurance plan you have and the services you are receiving from your provider.
How can I find out the amount I’m responsible for paying on a claim?
To find out the amount you are responsible for paying on a claim, log in and click the “My Account” tab at the top of the page, then click the “My Claims” link. Recent claims are listed on the “My Claims” page. If you do not see the claim you are looking for, you may search for a specific claim by the date of service. Once you have found the claim you are looking for, click on “Claim Details.” Look under the “Payment Responsibility” section for “Member” to find the amount you are responsible for paying.
Why is my HMO provider billing me?
Sometimes providers send statements to their patients before Blue KC has finished processing and paying the claim. You might see a note on the bill that says “Insurance Pending.” We will send you an Explanation of Benefits (EOB) once we have processed your claim. The EOB will tell you how much you owe to your provider. If you are still unsure if you owe the provider, call their billing office. Please note, if your provider was not in the Blue KC HMO network, you will be responsible for paying all services and fees for seeing that provider.
Why is my PPO provider billing me?
Sometimes providers send statements to their patients before Blue KC has finished processing and paying the claim. You might see a note on the bill that says “Insurance Pending.” If the provider you saw is in-network or contracted for payment from Blue KC, we will send you an Explanation of Benefits (EOB.) The EOB will tell you what you will be responsible for paying. If the provider you saw is out-of-network you will be responsible for paying the provider directly. Blue KC will process your claim. We will send you a payment for the amount that is covered by your plan. The EOB will explain how we calculated that amount.
I received a check from Blue KC. What is it for?
When you see an out-of-network provider, we send a check to you for the covered amount of those services. You are responsible for paying your provider directly. We will send you an EOB that explains how that amount was calculated.
What claim information is on the website?
A summary of your claims, the status of those claims and details regarding each claim can be found online. Log in and click the “My Account” tab at the top of the page, then click the “My Claims” link. Click on the “Claims Details” link on the right side of the page to see additional information about a specific claim.
How can I get a claim form?
To get a claim form, you can log in and click the “My Account” tab at the top of the page, then click the “My Claims” link. Links to claim forms can be found at the bottom of the page. You may also click on the "My Health Tools" tab at the top of the page to find claim forms.
For your convenience, you may also obtain a claim form by clicking one of the following links:
What do I do if I disagree with how my claim was processed?
If you have questions about how a claim was processed or you think it was processed incorrectly, please let us know. Call the number listed on your member ID card or log in and click on “Contact Us.” Please include your member ID number and the date of service in your e-mail.