A claim is a detailed invoice that your health care provider (such as your doctor, clinic, or hospital) sends to the health insurer. This invoice shows exactly what services you received.
Here’s how it works –
- You get a service from a health care provider.
- The health care provider submits a claim to Quartz.
- Quartz processes the claim according to your plan benefits. If you have to pay part of the bill, Quartz will send you a summary. This summary is called an Explanation of Benefits (EOB). It shows exactly what Quartz has paid for the service you received. It also shows the amount you may be billed by your health care provider.
- Your health care provider will send you a bill for the part of the charges you need to pay, if any.
It usually takes Quartz up to 30 days to process the claim and send the member an EOB.
If you don’t like to get a lot of paper in the mail, you can sign up to get Quartz’s EOB online.
How to submit a medical claim from a non-participating provider
Sometimes you may get services from a health care provider that is not in your network. In that case, you must send in the claim to Quartz. To do this –
- Fill out the Quartz Member Claim Form.
- Include a copy of the billing statement or claim form received from the doctor, clinic or other provider.
- Include receipts and / or proof of payment.
Note: Quartz processes the claim according to your plan benefits.
This claim must be mailed to Quartz within 90 days from the date of the service.
Sometimes it is not possible to send the claim to Quartz within 90 days. In these cases, Quartz will review claims received within one year of the service.
If you get medical care in another country, you must provide Quartz a copy of the claim in English. Include any papers that show you got and paid for the health care. Keep copies and send the originals to Quartz.