Getting Help With Eligibility & Claims

Getting Help With Benefits Eligibility & Claims

The plans have a review process that is followed whenever you submit a benefit claim or an eligibility claim. There are dedicated teams to assist you with both benefit and eligibility issues.

When you file a claim, the claims administrator reviews the claim and, in accordance with plan provisions, either approves or denies the claim (in whole or in part). The claims administrator will notify you of this action. In some situations, the plan may need additional time to process the claim (for example, if the plan needs additional information). In these cases, you’ll be notified of the extension and the additional information needed.

Connect with Your Health Pro

Understanding and using your health care benefits can be challenging. That is why BMC offers Health Pro, a personal and confidential health care navigation service available at no cost to all employees and their dependents.

Health Pro provides personalized support through a phone call or email. You simply reach out, talk to your Health Pro, and he will do the rest. From finding doctors and getting cost estimates for an upcoming procedure to finding more cost-effective medications, Health Pro can help.

Contact your Health Pro to help you solve any healthcare problem. Here’s what your Health Pro can do for you:

  • Clarify BMC’s health plans and programs—for instance, you can ask what your deductible is or if a specific treatment is covered
  • Find highly-rated, cost-effective medical, dental, and vision providers in your area
  • Schedule appointments
  • Coordinate care amongst your providers
  • Compare costs for procedures and services
  • Find lower-cost prescription options
  • Review your medical bills to make sure you’re not being over-billed

Whether you are trying to understand your benefits, verify care coverage, or resolve billing errors, Alight's Health Pro service can help. A dedicated personal Health Pro will work with you to eliminate the frustration and simplify your health care experience. Whenever you need assistance with any health care questions, email or call 877-262-4849, and your Health Pro will get to work for you getting you the information you need.

Getting Eligibility Help Through Claims and Appeals

If you have an issue with your claim dealing with eligibility for you or a covered dependent, Claims and Appeals can help. Claims and Appeals is a special group of Your Benefits Resources representatives dedicated to assisting you with your eligibility claims issues. Call Your Benefits Resources at 1-877-BMC-4849 for assistance. Claims and Appeals will conduct an initial review and determination.