How to File a Claim

When you see a doctor, some may require payment at the time of the visit. You will need to have a claim filed in order to have the covered maximum allowable costs applied to your deductible, or to get reimbursed as applicable after meeting your deductible.

Ask your provider to file a claim for you. Sample forms are below.

myChoice Claim Forms

Call a myChoice advisor for guidance on which form(s) to complete and file

Download UB-04 Download HCFA 1500

If the provider does not file the claim on your behalf, be sure to get all necessary information from your provider including a detailed statement of all the services provided. You will need to ask your provider to give you the correct procedure or diagnosis codes necessary to include. Call a myChoice advisor if you need help. Submit your complete claim form(s) by mailing to:

Payer Compass/myChoice
Payer ID PA331
PO Box 21035
Eagan, MN 55121

If your deductible has been met, and the services are covered, you will receive a reimbursement check to pay your provider. myChoice reimburses you up to 40% more than what Medicare pays (maximum allowable cost) for the same covered services.

Preventive care is covered at 100% of the maximum allowable cost when 1) the doctor’s office bills the claim as a preventive visit and 2) services are listed as preventive care under the Affordable Care Act (ACA). Amounts over the maximum allowable cost will be balanced billed to you.

Review of Medical Services

Certain medical services are subject to medical necessity, and must be reviewed (prior review) and approved by the Plan in order to be covered. This review process is explained in your benefit booklet in the Utilization Management section. The medical services that require prior review are:

  • Breast reduction surgery (unless associated with breast reconstruction surgery following mastectomy)
  • Genetic testing including BRCA
  • Lumbar spinal surgery
  • Spinal cord stimulation
  • Surgery for morbid obesity (bariatric surgery)
  • Venous insufficiency (varicose veins)

If you have any questions about filing claims, call a myChoice Advisor at 1 (844) 358-7960.

Maximum allowable cost

A set amount for a particular medical service. Your myChoice plan will pay up to this amount for covered medical services, once you meet your deductible.

Maximum out-of-pocket

The most you will pay for covered services during the plan year.

Deductible

The amount that you must pay before your myChoice plan begins paying for covered medical services.

Claim

The detailed invoice or statement your provider submits to your myChoice plan, showing services received and costs for those services. If your provider will not file your claim for you, you will need to file the claim yourself, following instructions available on the myChoice member portal.

Provider

Health care professionals and facilities, including doctors, nurses, hospitals and clinics.

Out-of-pocket costs

The amount you must pay for health care services, including deductibles.

myChoice Advisor

A representative available by phone to explain how the myChoice plan works, help you find the right provider, point you to online resources, and answer questions about billing statements and negotiating with providers. These Advisors can also speak to providers about how the plan works.

Healthcare Bluebook™

An online resource giving myChoice members price and quality data for providers in their area.