- How do I submit a claim when my physician or provider doesn’t bill insurance?
- If your provider doesn’t bill us directly, simply send us a copy of your itemized billing statement. Please make sure the statement includes your member identification number and the patient’s name. The member ID number is generally the social security number of the enrolled member or policyholder. The bill must also list the provider’s name and tax ID number, date of service, diagnosis, procedure codes and all charges.
- How long does it take to process a claim?
- We process most claims within 14 working days. However, if additional information is needed, if may take longer.
- Does my plan require prior authorization for certain procedures?
- Yes. Hospital admissions (exceeding 24 hours) and certain outpatient procedures require prior authorization. Although most providers will handle the actual process, you are responsible for informing your physician or provider of this requirement. Because Oregon regulations now conform with new federal standards, you will receive a letter from us confirming the results of a request for prior authorization. We process these letters within 24 hours of the request.
- How do I find out if my doctor is a LifeWise Preferred Provider?
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Although the listing will be subject to change, you can look for a LifeWise Preferred Provider on our online directory.
Please call our Customer Service Representatives at 1-800-777-1502 to confirm the status of a provider. This is the only way to provide you with up-to-date information about your plan benefits.
Many factors cause changes in a provider’s status, including changes in location and practice groups. It is important to check status regularly.
- Do I need a referral to see a specialist?
- No, LifeWise plans do not include requirements for a "primary care provider or gatekeeper."
However, if your plan is a preferred provider plan, referrals may be made to physicians or facilities that are not contracted as LifeWise Preferred Providers. If this occurs, benefits will still be paid for covered services but may be paid at the Non-Preferred level.
- What if I have an emergency and am not near a Preferred Provider?
- You have coverage for emergency care as outlined in your plan. Covered services for a medical emergency will be paid at the preferred provider level associated with your coverage. This also applies if the emergency occurs outside of Oregon or the United States. Non-emergency covered care is also covered outside of Oregon or the U.S., but at the non-preferred level.
- What do I do if I receive an accident report but didn’t have an accident?
- If something on your claims appears to be due to an accident, you will receive a LifeWise Accident Report form. It is important to complete and return this form as soon as possible – even if you didn’t have an accident. Because benefits vary on some plans when an accident occurs, we need to determine quickly how to correctly pay your claim. If we don’t receive the information, delays will occur in processing.
- What is UCR and can I look it up somewhere?
- UCR stands for "Usual Customary and Reasonable." Benefits based on UCR are processed using a national database. The data is frequently updated based on charges by providers in the same location with similar experiences. Because this data varies and is dependent on the final diagnosis and treatment codes, there is not a reference source available to the general public to determine the UCR amount ahead or time.
