Other Insurance

OPL Frequently Asked Questions

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Why was my claim denied as being an auto accident? I was working on the car; the car wasn't in motion.

Your contract excludes benefits for health services resulting from accidental bodily injuries arising out of contact with a motor vehicle. This means even though the car wasn't in motion, a car was involved in the accident and you need to file the claim with the motor vehicle insurance carrier before payment can be considered by Blue Cross and Blue Shield of Kansas.

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I was injured in an auto accident. What do I need to do to get my health claims paid?

First, you need to file a claim with your automobile insurance carrier. Then, you need to send us a complete itemized statement with the following information; provider of services, dates of services, total charges, amounts paid by auto insurance, to whom payment was made and a statement that automobile insurance benefits are exhausted.

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My health services won't be paid by worker's compensation or auto no-fault. Why do I need to send information from the worker's compensation/no-fault carrier?

We need evidence that claims were submitted to and considered by the workers' compensation/no-fault carrier before we may consider services for eligible benefits. Your contract excludes coverage for services which are eligible under these carriers.

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Why is my claim considered one that may be covered by workers' compensation benefits? I wasn't working or on company time. I fell in the parking lot.

Injuries occurring on the job, on company property or as the result of occupational circumstances must be submitted to the patient's workers' compensation carrier for consideration before being considered by Blue Cross and Blue Shield of Kansas.

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Why are my claims still being denied as "work related"? The doctor has released me, I made a settlement and workers' compensation is not going to pay for any more services.

The claim is not eligible for payment. Your contract states that "if you enter into a settlement giving up your right to recover future medical benefits under a workers' compensation law, Blue Cross and Blue Shield of Kansas will not pay those Medical benefits."

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What can I do to have Blue Cross and Blue Shield of Kansas as primary insurance carrier for my children? My ex-spouse is supposed to cover them but I don't know where he/she is; he/she refuses to provide insurance coverage.

Send us, in writing, the facts stating that the parent with the obligation is not carrying such insurance as decreed.

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Why do I receive a questionnaire every year regarding other insurance coverage?

This is a routine cost containment procedure. In order to keep records as up to date as possible, we attempt to reverify on a yearly basis that our insureds have no duplicate coverage.

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