What If I Get a Bill?
If you pay for your covered services or drugs, or if you receive a bill, you can ask us for payment.
Our network providers bill the plan directly for your covered services and drugs. If you get a bill for the full cost of medical care or drugs you have received, you should send this bill to us so that we can pay it. When you send us the bill, we will look at the bill and decide whether the services should be covered. If we decide they should be covered, we will pay the provider directly.
If you have already paid for services or drugs covered by the plan, you can ask our plan to pay you back (paying you back is often called "reimbursing" you). It is your right to be paid back by our plan whenever you've paid more than your share of the cost for medical services or drugs that are covered by our plan.
When you send us a bill you have already paid, we will look at the bill and decide whether the services or drugs should be covered. If we decide they should be covered, we will pay you back for the services or drugs.
Send us your request for payment, along with your bill and documentation of any payment you have made. It's a good idea to make a copy of your bill and receipts for your records.
Mail your request for payment to these addresses. Be sure to include any bills or receipts.
For medical services:
Keystone First VIP Choice — Member Reimbursements
P.O. Box 7137
London, Kentucky 40742-7137
Keystone First VIP Choice
Attention: Direct Member Reimbursement
200 Stevens Drive, 4th Floor
Philadelphia, PA 19113
You must submit your claim to us within 12 months of the date you received the service, item, or drug.
If you have questions, call Member Services at 1-800-450-1166 (TTY 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31. If you don’t know what you should have paid, or you receive bills and you don't know what to do about those bills, we can help. You can also call if you want to give us more information about a request for payment you have already sent to us.
For more information on situations in which you should ask us to pay for your covered services or drugs, see chapter 7 of the Evidence of Coverage (EOC) (PDF).