Why ClaimDOC?

Controlling Costs And Putting Money Back In Your Pocket

Your employer has partnered with ClaimDOC to provide a health plan with greater cost control and transparency. Your employer has made this decision with you in mind. Workers across the country are suffering from reduced benefits with increased costs. This program can lead to reduced premiums and out-of-pocket expenses.

ClaimDOC audits medical claims and ensures providers are reimbursed at a fair and reasonable rate. Your employer could have selected a discount model for auditing, however, they selected ClaimDOC due to our most valued service—extraordinary member advocacy. We’re here to help you navigate this complex healthcare system and help create a great experience.

How Your Plan Works

Your employer’s self-funded health plan has put you in the driver’s seat when it comes to managing your healthcare. You’ll love the freedom to choose your providers without the limitations of a network.

At ClaimDOC, we’re here to support you every step of the way, making sure you get the care you need from the providers you choose.

Pave the Way®

Since your plan is open-access and not associated with a traditional insurance carrier, some physicians or facilities will not be familiar with your health plan. Just tell us who your healthcare providers are, and our Member Advocates will reach out to them, making sure they're set up to submit claims for your care.

At Your Appointment

When it's time to see the doctor, be sure you take your medical plan ID card. You'll be responsible for any copay during your visit. If the medical staff isn't familiar with your health plan, just have them give us a call.

Life of a Claim

Following the appointment, your healthcare provider submits a medical claim to your plan administrator. We'll review the claim, make sure it's accurate, and determine a fair reimbursement rate for the care you received.

Check Your Mail

After your medical claim is processed, you will receive an explanation of benefits (EOB). This is not a bill, but a statement that lists details of the services your healthcare team provided and how your medical benefits were applied. Be sure to pay close attention to the "Patient Responsibility" section of the EOB as this will indicate what you owe the provider. If you receive a bill with an amount greater than what is indicated in the "Patient Responsibility" box on your EOB, give us a call so we can review.

Provider Nomination Form

Want to make sure we're working with your healthcare provider? Send us their contact information and a ClaimDoc Member Advocate will contact them to make sure everything's set for your next visit.

Submit a provider

Member Stories

We work with each member to meet their unique needs. That includes lightening their load by offering a listening ear and the expertise to help with any health situation. We love to hear from you when we make a difference in your day!

Pave the Way™ program made things a lot easier

After learning about our Pave the Way™ program during his enrollment meeting, David suggested adding his physician. One of our member advocates, Austin, reached out to his physician and helped get started with his plan.

“Thank you so very much for all your assistance today! I thought it would be hard to add a new provider to the plan. To the contrary, you've made it a very easy process. I'll definitely be singing your praises to all of my peers!”
David

Statement audit saved this member hundreds of dollars

Ellen was billed a copay of $2,000 after a visit to the hospital. Unsure about the charges, she contacted Karen for help. Her review uncovered an error that dropped her copay down to $250.

“Thanks for the great news! It certainly takes a weight off of my shoulders! I’ll definitely reach out if something comes up in the future! Thanks again for all your work!”
Ellen

FAQs

How can ClaimDOC help me?

ClaimDOC provides you with dedicated member advocacy made up of real people with real-life experiences, just like yours. We understand that health care and benefits can be complicated—we’re here to help you navigate your health plan. Reach out to us if you need assistance with finding a doctor or facility for your medical treatment, introducing your health plan to your current providers, understanding your open-access plan, understanding your medical bill, or navigating your medical plan.

What if my health care provider isn’t familiar with my new plan?

The ClaimDOC Pave the Way program is designed to ensure you have access to your preferred health care providers. Prior to your visit, a ClaimDOC Member Advocate will contact your provider to ensure that they have the necessary information to submit claims to your health plan.

Submit your provider’s information by completing a provider nomination, or give us a call.

Where can I access my benefits information?

You can access your benefits information by contacting your health plan’s administrator. This information is located on your medical ID card. If you do not have a medical ID card yet, give us a call and we’ll make sure you’re connected with the appropriate party.

What is my financial responsibility for medical services?

Prior to your service, you may review your Summary of Benefits and Coverage (SBC) which provides you with details regarding your coverage, such as copays and deductibles. At the time of service, you are only responsible for a copay, if it’s applicable to your benefit plan.

Following your medical service, you will receive a document from your plan administrator titled Explanation of Benefits (EOB). This document describes your visit and informs you how much you owe the provider, if anything. The EOB is not a bill—it’s just for your information. If you receive a bill that is different than what is reflecting in the “Patient Responsibility” section of your EOB, call a ClaimDOC Member Advocate for assistance.

Do you have a glossary with the terminology you’re using?

Yes! We understand that health care jargon can be confusing. View our glossary that puts these terms in simple language.

Don’t see your question here?

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An affordable healthcare plan you can count on