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• Filing Medical Claims for Services from Nonparticipating Providers

  Providers will usually submit claims for you. If they don't, you can submit a claim yourself by following these steps.

• HMSA Medicare Advantage Member Appeals

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• Payment Determination Criteria

  HMSA applies payment determination criteria to determine if a service or supply is covered by your plan.

• How to Appeal an HMSA Decision as a Commercial Member

  An appeal is a formal way of asking HMSA to review a decision on a denied claim. Learn more about the process.

• Dental Appeals

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• When Prior Approval (Precertification) is Denied or Not Requested

  If your precertification request is denied and you disagree with HMSA's decision, you or your provider may submit an appeal.

• What's an Eligible Charge?

  The eligible charge is the lower of the participating provider's actual charge or HMSA's maximum allowable fee.

• What's a Lifetime Maximum?

  A lifetime maximum is the maximum dollar amount that will be paid on your behalf under your HMSA plan.

• Services Your Plan Doesn't Cover

  Our benefits are designed to keep you safe, promote correct use of services, and keep health care costs down.

• Request For Insurance Commissioner External Review

  You can ask to have an independent review organization look over your appeal if you think we made a mistake.

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