How to file a claim

Claims for health care should be filed with the claims administrator
employees at control panel

COVID-19 Extension for Filing Claims and Appeals

Due to the COVID-19 Pandemic and Declaration of National Emergency, the US Departments of Labor (DOL) and Treasury/IRS have provided revised guidance that extends deadlines related to filing claims and appeals under ERISA plans. The guidance states that every affected individual gets an extension to take actions based on when their claims event occurred. This extension applies to the following deadlines discussed in this claims section:
  • Filing a claim;
  • Appealing a claim denial;
  • Requesting an external review; and
  • Filing information needed to complete/perfect an external review request.
The extension pauses the deadline to take the above actions until the “Outbreak Period” for that individual is over. For each claims event, the Outbreak Period ends on the earlier of:
  • One year after the period starts for that event; or
  • 60 days after the Declaration of National Emergency ends. (The Declaration was recently extended and is still ongoing.)
Essentially, the claims and appeals deadlines for the actions listed above are extended (delayed) until the earlier of one year after the Outbreak Period starts for that event, or 60 days after the emergency declaration ends. The normal deadlines then apply. Here is an example:

Assume the National Emergency does not end until November 30, 2022. Kendrick submits a claim on August 1, 2021. The claim is denied on August 5, 2021. Under the plan, Kendrick would normally have 180 days to appeal the claim. However, Kendrick’s Outbreak Period for his appeal does not start until he receives his claims denial. Kendrick’s Outbreak Period will end on August 4, 2022. He will have 180 days after that to submit his appeal.

The rules for these extensions are complex and subject to change. Please contact the bp Benefits Center for assistance. However, since the end of the extension period is currently unknown, please do not delay submitting your claim or appeal in a timely manner.

Deadline for filing claims

To receive benefits under the BP Medical Plan, you must submit all claims to the applicable claims administrator within 12 months of the date of service. Any claims that the claims administrator receives more than 12 months after the date of service will not be paid.

Need help with claims issues?

The Advocacy Service is available to help you with issues regarding health care claims and services. Advocacy team members work with you and the claims administrator to understand, research and resolve claims issues.

You must make at least one attempt to contact and resolve your issue directly with the appropriate claims administrator before contacting the Advocacy Service.

To reach the Advocacy Service, call the bp benefits center. Keep in mind that your issue may not necessarily be resolved in your favor, as the terms of the plan will apply in all situations. 

Responsibility for filing claims

The following can help you determine when providers will file claims on your behalf and when you must file claims directly with the appropriate claims administrator.
 
 
PPO Options, including Health+Savings PPO
Out-of-Area Options, including Health+Savings OOA
Medical and behavioral health care
In-network Provider files medical claims. You may have to pay for services at the time you receive them and file a claim with Aetna for reimbursement.
Out-of-network You pay for services and file a claim with Aetna. You pay for services and file a claim with Aetna.
Prescription drugs
In-network Provider files claims. Provider files claims.
Out-of-network You pay for services and file a claim with ESI. You pay for services and file a claim with ESI.
 
To file a claim for reimbursement, you will need to submit the following to the claims administrator:
  • A completed claim form.
  • All itemized bills indicating the date of service, description of service provided, diagnosis, name of the provider and charges incurred.
You can request claim forms from the claims administrator or download them from the claims administrator’s Internet site. A list of claims administrators is available under Administrative Information.
 
If you have other medical coverage

Periodically, a claims administrator will ask you to provide information about other medical coverage you and/or your eligible dependents may have. This request may occur in connection with a claim you have submitted. In that case, you will be advised that the other medical coverage information, including an Explanation of Benefits (EOB) from the other coverage’s administrator, is required before your claim can be processed.

Your claim will not be processed until you comply with the claims administrator’s request.
 

Health Savings Account (HSA) Debit Card

Your share of the cost for eligible medical expenses you incur may be paid to the provider through your PayFlex Card® (your HSA debit card), if you contribute to the HSA and have an available balance in your account. Note: You cannot use the HSA debit card outside the U.S.
 

 

Publication date: April 2021

 

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