HOW DO I CHECK THE STATUS OF MY CLAIM?
I AM A NEW UNITEDAG MEMBER. BEFORE RECEIVING MY ID CARD, I NEEDED TO GO TO THE DOCTOR. MY DOCTOR REQUIRED I PAY FOR THE SERVICE. WHERE SHOULD I SEND MY CLAIM?
Once you have received your ID card:
- Print and complete a medical claim form: California claim | Out of state claim
- Submit the form, and a copy of the doctor's bill (indicating payment), to the address on your health ID card. Be sure to include your member ID number.
HOW DOES UNITEDAG DETERMINE IF MY CLAIM IS A POSSIBLE ACCIDENT?
Examiners will review a claim upon submission, if the claim is submitted with a possible accident diagnosis the examiner will issue a pend letter to the member requesting possible accident details. At this time the examiner may also request if the possible accident is work related or if it is the results of a MVA. Once the accident details have been received they will be reviewed by our Claims Department, if additional information is required we will issue a letter requesting necessary information like lien, police report, doctor’s office notes etc. If no additional information is required, the claim will be paid.
IF MY CLAIM IS A POSSIBLE ACCIDENT, WHAT CAN I DO TO HELP UNITEDAG PAY MY CLAIM?
The most expedient way to help your claim along is to respond to the request for information in a timely manner. Responses can be sent to our mailing address, submitted electronically, or many times can be called in to our Member Service Department.
IS DIFFERENT INFORMATION REQUIRED FOR AN INJURY/ACCIDENT VS. MVA?
Pend letters are issued when a claim is processed, if a claim is pended for additional information a follow-up request will be issued 30 days after the original request. If after 2 request the information is not received the claim will be closed until the informatio
WHAT HAPPENS IF I DO NOT RESPOND TO UNITEDAG'S REQUEST FOR INFORMATION?
Pend letters are issued when a claim is processed, if a claim is pended for additional information a follow-up request will be issued 30 days after the original request. If after 2 requests the information is not received the claim will be closed until the information is received. Information must be received in a timely manner in order to remain eligible for processing.
IS THERE A TIME LIMIT ON APPEAL SUBMISSIONS?
A written appeal should be filed within 180 days of the date of the notice. Appeals should include members name, member’s identification number, the claim number, the reason for your appeal and any other information you feel may help in reviewing the claim.
WHAT IF I STILL DO NOT AGREE WITH THE DECISION OF THE BENEFIT ADMINISTRATOR, CAN I APPEAL TO A HIGHER AUTHORITY?
If you disagree with the conclusion reached by the Benefit Administrator, you may file a written appeal or request a formal hearing of the Board of Trustees within one hundred eighty (180) days of receipt of the Benefits Administrator’s review. Board of Trustee appeals should be addressed to:
United Agricultural Benefit Trust
C/O Board of Trustees
ATTN: Trust Counsel
54 Corporate Park
Irvine CA, 92606
Or e-mail to: firstname.lastname@example.org
If you disagree with the decision of the Board of Trustees, you have the right to request an external review of your claims within one hundred twenty (120) days after the date of receipt of the Trustee’s benefit denial. Because UABT is licensed in California, the Department of Insurance has provided participants the phone number to contact them and report problems or concerns, therefore, there are times when CA, Department of Insurance become involved with a complaint by the participant (but this is not an appeal as defined by ERISA). Once all administrative review options have been exhausted and the appeal has been though the external review process than participants may take the claim to Federal Court.