Members - FAQs - OPL
Frequently Asked Questions (FAQs)
Other Party Liability (OPL)
How is payment made for duplicate coverage?
The provision ensures that our customers do not receive duplicate payments for the same claim through multiple health insurance policies or carriers. Payment between two (or more) carriers may not exceed the total charge of the claim.
How do I file for secondary coverage?
Submit an itemized claim with the primary carrier's Explanation of Benefits attached. Mail it to:
Blue Cross and Blue Shield of Kansas
1133 SW Topeka Blvd.
Topeka, KS 66629-0001
Be sure to include your Blue Cross and Blue Shield of Kansas identification number.
What should I do if my workers' compensation insurance denies my claim?
If workers' compensation denies services or releases you from care, a letter of denial or release from the workers' compensation carrier must be sent to BCBSKS before benefits can be considered under your health insurance coverage.
What happens if I am hurt at work?
If you suffer an injury or illness on the job, contact your employer as many work-related injuries and illnesses are compensated under workers' compensation. When reporting accident information to your health care provider, please be specific. If the accident is job related, tell the provider so he or she can send the claim to the appropriate insurance company for processing.
How do I file a claim if I am injured in an automobile?
If your Personal Injury Protection (PIP) benefits become exhausted (your maximum dollars have been paid), supply us with the motor vehicle insurance carrier's itemized statement indicating the amount of coverage available for medical, and what medical bills these benefits paid. Then remaining services will be considered for payment subject to the benefits available under your BCBSKS policy.
How do I fill out OPL forms?
Read the instructions carefully. Your form letter may contain one or more sections. Please answer each question as best you can. If your form is asking about an accident and the patient was not involved in an accident, please give an approximate onset date and describe the nature of the condition or illness. If your form asks questions about other health insurance coverage, only list actual GROUP HEALTH insurance carriers. You may answer NO if your other coverage is Medicare, Medicaid, AARP, disability, cancer, accident or liability coverage. If you need more assistance in filling out your form, please contact us.
What should I do if my claim is denied because it needs to be sent to the automobile insurance carrier or workers' compensation carrier?
File the claim with the appropriate insurance carrier; automobile PIP insurance or workers' compensation carrier. If that carrier denies coverage, send us a letter of denial (including the reason for denial) and your claim will be reconsidered for payment.
How do I file for secondary benefits with BlueCard?
When you are filing a claim for secondary benefits, the claim cannot be processed through the BlueCard claims processing system. You must file that claim directly with your "home" Plan for processing of your secondary claim balances. If BCBSKS is your "home" Plan, submit an itemized claim with the primary carrier's Explanation of Benefits form attached. Mail it to:
Blue Cross and Blue Shield of Kansas
1133 SW Topeka Blvd.
Topeka, KS 66629-0001
Be sure to include your Blue Cross and Blue Shield of Kansas identification number.