FREQUENTLY ASKED QUESTIONS
What is the fastest, easiest way to submit claims?
Drop them off in person on the 1st floor at HPOU or fax them to 832-200-3470. Make sure they are legible!
What if I didn’t keep my receipts after my appointment?
You can request a duplicate or an invoice from your doctor. Most medical insurance companies let you view and print your claims or Explanation of Benefits online after you sign up for a member account. If you are on Cigna with the City of Houston, go to mycigna.com to log in.
What is an Explanation of Benefits and why are you asking for it?
It is a document from your insurance company that explains your coverage and charges for services provided by a doctor or hospital. We might request one from you to get more information about your receipt in your claim.
If my copay was less than what you reimburse, can I turn in another receipt for the remaining amount later?
Yes, we will reimburse the remainder of your benefit until you reach your plan limit.
Why didn’t I get reimbursed?
-Your receipt didn’t have a patient name, date(s) of service, copay amount, or the type of service that was provided.
-Your date of service was over 12 months ago.
-You reached your plan limit.
-The service provided to you isn’t reimbursed under your plan.
Appeal request Procedure
Have I reached my limit?
Keep copies of the receipts you submit and add your copay amounts to check if they meet your plan limits. You can also call us at 832-200-3410 to check.
How do I make a claim for reimbursement?
- Check which plan you are enrolled in. You can call us at 832-200-3410 or come to the 1st floor at HPOU and ask.
- Fill out the Medical Supplement Claim Form.
- Collect your copay receipts that are reimbursed under your plan and bring them to us. You can also mail or fax them to us.
- Let us know if you would like to add any dependents or a spouse to your plan.
- Look for a reimbursement check in the mail in a few weeks.
What do my receipts need to show to be reimbursed?
- Patient name
- Date(s) of service
- Copay amount
- Service provided (printed on the original receipt by the medical facility if it was an office visit, outpatient surgery, etc.)
Does the vision benefit under the Medical Supplement reimburse eye exams?
Only the cost of your glasses and contacts is reimbursed. You need to use your vision plan to cover eye exams.
Does the outpatient copay benefit reimburse my X-Ray?
There is a reimbursement benefit set aside for radiology or imaging under the Active Medical Supplement plan only.
How long can my son or daughter stay on my reimbursement plan?
Up to age 26 or until they have their own medical insurance.
Do you reimburse Dental work?
No, we don’t reimburse any Dental copays.
Do you reimburse lab work?
We don’t reimburse pathology or lab work charges.