How to Make a Claim

CLAIM FILING PROCEDURES

The claim filing procedure under the Health & Welfare Fund is intended to help process your claims as quickly as possible. Claims filed later than ninety (90) days after date of treatment or hospital confinement began may be denied, unless there is satisfactory explanation for the unavoidable delay. However, in no event will the Fund consider any claim filed more than one (1) year of the date of service. Additionally, you must provide all necessary information at the time the claim is filed. Any claim form received with incomplete information will cause delays in processing.

How to File a Claim for Death Benefits

In case of the death of a member, an authorized representative MUST PROVIDE A CERTIFIED DEATH CERTIFICATE. Your representative will be furnished the necessary forms, which must be completed and returned to the Fund Office for payment of the claim. All claims must be filed within ninety (90) days of the date of the member’s death.

How to File Medical or Hospital Claims (Union Members)

Where pre-authorization is noted, American Health must be contacted at 1-866-457-0533, prior to the rendering of any service. For all other benefits, there generally are no claims to you to file because the providers will submit the claim form to BlueCrossBlueShield/Anthem, on your behalf, pursuant to their contract with the respective PPO Network. However, if you desire to submit a claim form on your behalf, you may print a claim form and have it completed by your doctor, then mail it to the address below. You may also submit a claim for benefits on the universal HCFA-1500/UB92. To assure prompt processing of your claim, you must make sure all claims have the following:

  • Name of Member
  • Member’s ID Number
  • Name of Patient
  • Date of Service
  • Type of Service (with appropriate codes)
  • Diagnosis
  • Amount of Charge
  • Physician or Hospital Name and Address
  • Physician or Hospital TIN Number and/or ID Number

All hospital and medical claims are to be submitted to:

Empire Blue Cross and Blue Shield

P.O. Box 3877

Church St. Station

New York, NY 10008

How to File Dental Claims

When you or your eligible dependent need dental treatment, call the dental service (1-800-468-0600) for the nearest participating dental office to your home or place of employment. Call the participating dentist and be sure identify yourself as a participant of Local 348 when you make your appointment. Your dentist will verify your eligibility with the dental service. No form or card is needed. You may contact the Fund office for a list of providers in your area.

How to File Your Optical Claims

If you are seeing an optometrist or optician affiliated with the Comprehensive Professional Systems and Vision Screening, Inc. networks (applicable to New York and New Jersey residents only), you should call the Fund Office at 718-745-3487 option #5, to obtain a voucher. The provider will submit any claim for benefits on your behalf, pursuant to his/her contract with Comprehensive Professional Systems and  Vision Screening.

To check on the status of a claim:

Basic, Regular and Restaurant Depot JETRO Members call: 1-800-393-1135

Major Medical and 19D call: 1-877-347-7225

To locate a medical provider or hospital call: 1-800-810-BLUE or view www.anthem.com

PPO Networks

Empire Blue Cross Blue Shield/Anthem: As part of our continuing efforts to deliver the best and most cost effective health plan, BCBS now provides the Plan’s PPO Network. There is no change in the level of benefits under this plan. www.anthem.com

Healthplex: provides dental benefits and administrative services for insurance companies, HMOs, school districts, labor unions, families, municipalities, welfare funds and businesses of all sizes. www.Healthplex.com

Magnacare: Magnacare provides a full scope of Pharmacy Benefit Management services. They manage the clinical aspects of Pharmacy Benefit Management, such as Disease Management, Formulary, Drug Utilization Review and audits, among other things.  www.MagnaCare.com

Comprehensive Professional Systems and Vision Screening: With experience in the optical field for over 30 years, Comprehensive Professional Systems and  and Vision Screening have put together a group of professionals with the same vision for standard in excellence when it comes to providing eye care. They believe that proper credentialing, quality control, and customer service are the keys to every plan it administrates. www.cpsoptical.com and www.VisionScreeningInc.com