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How Do Health Insurance Claims Work?

Life of a Claim

A claim is a detailed invoice that your health care provider (such as your doctor, clinic or hospital) sends to the health insurer. This invoice shows exactly what services you received.

  1. Member has a service from a health care provider
  2. The health care provider submits a claim to Unity
  3. Unity processes the claim according to your plan benefits. If you have to pay part of the bill, Unity will send you a summary. This summary is called an Explanation of Benefits (EOB) statement. It shows exactly what Unity has paid for the service you received. It also shows the amount you may be billed by your health care provider.
  4. Your health care provider will send you a bill for the part of the charges you need to pay, if any.

Unity processes claims within 30 days of receipt unless more information is required to process the claim (investigation), such as itemization from a provider or other insurance information.

Currently, we process 100 percent of non-investigated claims within 30 days and 100 percent of investigated claims within 60 days.

Note:  Some providers may not be able to send their claims electronically to Unity. That means  they may take longer to arrive at Unity. However, but Unity will still process these claims within 30 days of receipt. (Unless more information is required to process the claim).

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