HealthPartners member claims

These are claims related to medical care, services or products covered under your HealthPartners medical insurance plan.

In-network providers are required to submit claims on your behalf. If your provider is in network, check to make sure they have your current insurance information on file. If you need further assistance, call Member Services at the number on the back of your member ID card or send us a message.

If you used an out-of-network provider for covered care, services or products, ask if they’ll submit a claim to us on your behalf. If they won’t, you can send us an itemized statement or detailed receipt (and supporting documentation) to get reimbursed for amounts you owe out of pocket that are covered by your plan. You may need to work with your provider to get the necessary information to file your claim.

These are claims related to dental care, services or products covered under your HealthPartners dental insurance or Medicare plan.

In-network providers are required to submit claims on your behalf. If your provider is in network, check to make sure they have your current insurance information on file. If you need further assistance, call Member Services at the number on the back of your member ID card or send us a message.

If you used an out-of-network provider for covered care, services or products, ask if they’ll submit a claim to us on your behalf. If they won’t, the out-of-network claim process depends on whether you have:

• A dental insurance plan with us; OR
• A Medicare plan with us that covers dental services

Send us an itemized statement or detailed receipt (and supporting documentation) to get reimbursed for amounts you owe out of pocket that are covered by your plan. You may need to work with your provider to get the necessary information to file your claim.

If you need to get reimbursed for amounts you owe out of pocket that are covered by your Medicare plan, you can send us a request:

• Download the dental out-of-network reimbursement form for Medicare plans through our member forms page, and return it to us. Be sure to include all information and documentation that’s asked for, including dated receipts, itemized bills, and dental codes and service descriptions for each service you’re requesting reimbursement for.
• You may need to work with your provider to get the necessary information to file your claim.
• We must receive your request within 12 months of the date you received your dental service(s).
• If you’ve already paid your provider, we’ll reimburse you for covered amounts. If you haven’t yet paid your provider, we’ll reimburse your provider for covered amounts.

These are claims related to prescription medicines covered under your HealthPartners medical insurance or HealthPartners prescription drug plan. (Please note that some employers use insurers besides HealthPartners to cover prescription medicines. If this applies to you, you’ll have a separate ID card from a separate company for your pharmacy benefits, and you’ll need to contact that company regarding how to submit a claim.)

Generally, your HealthPartners insurance will be checked when you fill your prescription at the pharmacy counter or receive a prescription in a medical facility. This creates an automatic claim, and the price you pay out of pocket factors in your insurance benefits.

If your insurance wasn’t checked when you filled your prescription and you paid full price out of pocket for a prescription, you can send us a claim to get reimbursed under your coverage:

• Download the pharmacy claim form through our member forms page, and return it to us along with your supporting documentation.
• You may need to work with your pharmacy or provider to get the necessary information to file your claim.

These are claims related to an FSA or HRA administered through HealthPartners.

If you have a HealthPartners insurance plan in addition to a HealthPartners-administered FSA or HRA, you’ll automatically receive a reimbursement equal to what you owe your provider out of pocket (after your insurance benefits are factored in). You can opt out of automatic claims submissions – download the form through our member forms page, and return it to us.

If you didn’t use your HealthPartners insurance, or if you don’t have HealthPartners insurance, you can also submit a manual FSA or HRA claim. Your claim must be for eligible medical expenses, and documentation is required.

You must have sufficient funds in your FSA or HRA for any claim, automatic or manual, to process in full.

Some of our group plans through an employer or other organization include travel benefit coverage.

Under this benefit, when you or someone on your plan receives a covered medical service that isn’t available within a geographic distance specified by your plan, we’ll pay for eligible travel expenses – so long as the covered service was performed legally (according to local laws where the service took place) within the United States:

• Download the travel benefit claim form through our member forms page, and return it to us along with your supporting documentation.
• Not sure whether you have travel benefit coverage or what your plan’s requirements are? Contact your plan administrator, call Member Services at the number on the back of your member ID card or send us a message.