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Claims and Statements

What is a claim?

A claim is a request for payment that your health care provider submits to your health insurance plan.

How can I view my claims?

You can view your claims through the Member Portal by clicking on View My Claims or request a copy by contacting our Claims Department at 1-800-352-9824 Ext. 5010.

Who do I call if I have a question about a claim?

Call the Member Services Department to review your claim 1-800-352-9824.

What if I have a denied claim?

  • You may submit an appeal to Member Services by email, fax or by mail. Indicate your name, address, member number, claim number, date of service, why you believe the claim should be paid, and your best contact information.
  • The appeal will be assigned to a counselor who will contact you directly. Email, fax 386-676-7149 or by mail Florida Health Care Plans, PO Box 9910, Daytona Beach, FL 32120-9910.

How do I know what is covered under my plan?

  • Find your schedule of benefits for your plan on the Member Portal. This document will outline your plan and provide you with copay and coinsurance amounts for services, facilities, therapy options, and testing.
  • Request a printed copy from the Member Services Department at 1-800- 352-9824.

Where can I find how much I have paid for the year?

You can view your max out of pocket (MOOP) through your member portal or request a copy from our Member Services Department at 1-800-352-9824.

How can I determine my cost share for procedures?

Ask your provider for the CPT codes for the procedure and call our cost estimation line for an estimate for your procedure. Contact our Cost Estimator Center at 1-800-352-9824.

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