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 –

  1. You get a service from a health care provider.
  2. The health care provider submits a claim to Unity.
  3. Unity processes the claim according to your plan benefits.  If you have to pay part of the bill, Unity will send you a summary. This summary is called an Explanation of Benefits (EOB). It shows exactly what Unity has paid for the service you received. It also shows the amount you may be billed by your health care provider.
  4. Your health care provider will send you a bill for the part of the charges you need to pay, if any.

It usually takes Unity 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 Unity’s EOB online.MyChart link

 

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 Unity. To do this –

  1. Fill out the Unity Member Claim Form.
  2. Include a copy of the billing statement or claim form received from the doctor, clinic or other provider.
  3. Include receipts and / or proof of payment.

Note:  Unity processes the claim according to your plan benefits.


This claim must be mailed to Unity within 90 days from the date of the service.


Sometimes it is not possible to send the claim to Unity within 90 days. In these cases, Unity will review claims received within one year of the service.


If you get medical care in another country, you must provide Unity 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 Unity.

 

Pharmacy Claims

To submit a claim for medicine (prescriptions), fill out a Direct Member Reimbursement Claim Form.


Contact Unity Pharmacy Services for pharmacy claim questions at 800.788.2949.


Members covered under the State of Wisconsin health insurance program should contact Navitus Health Solutions to learn more about their prescription drug benefits.

BadgerCare Plus members should contact the State Medicaid program at 800.362.3002.

Claim Profiles

You can find a summary of claims that Unity has processed in MyChart.MyChart link


The profile includes dates of service, health care provider names, total charges, amounts paid by Unity, copayment or deductible amounts.

 

Questions?

Get in touch with Unity Customer Service by sending a message.MyChart link