Download SureGo Claim Form and fill out it.
The claims materials that need to be submitted are as follows:
1) Completed Claim form
2) Your Insurance ID Card
3) Original itemized invoices with fees on Physician/Hospital letterhead.
Invoice must include patient’s full name, date of birth, Diagnosis (type of Illness), date of the visit, Treatment type, Physician’s charges
4) The acceptable proof of payment (credit card receipt)
Send the claim materials to claims@mysurego.com and CC to info@isabenefit.com
Tips:
* If the member paid the bill, the member need to file the claims within 180 days of the date of Service to be eligible for reimbursement of covered expense.
* The claim processing is 30 working days after submitting all the claim materials. If you have not received any notification within 30 working days, please contact ISA customer service. We will confirm the claim progress for you and check whether there are any problems with the claim materials.
SureGo
Toll Free: +1 (866) 264-7299
Direct: +1 (251) 322-7404
For Student Health Center or Non Network Bill
Step 1
Download the Five Points Claim Form that applies to your case and complete the fields.
Step 2
The claims materials that need to be submitted are as follows:
1) Completed Claim form
2) Your Insurance ID Card
3) Original itemized invoices with fees on Physician/Hospital letterhead.
Invoice must include patient’s full name, date of birth, Diagnosis (type of Illness), date of the visit, Treatment type, Physician’s charges
4) The acceptable proof of payment (credit card receipt)
Step 3
Send the claim materials via the following one method
Email: claims@fivepointsmecplan.com and CC to info@isabenefit.com
Fax: +1.915.519.0261
Mail: 6006 N. Mesa Street – STE108, Coronado Tower El Paso, TX79912
Tips:
* If the member paid the bill, the member need to file the claims within 90 days of the date of Service to be eligible for reimbursement of covered expense. If the claim is denied, you can submit a claim appeal to the insurance company within 180 days, and the insurance company will review your claim based on your additional materials.
* The claim processing is 30 working days after submitting all the claim materials. If you have not received any notification within 30 working days, please contact customer service. We will confirm the claim progress for you and check whether there are any problems with the claim materials.
Claim/Benefits consultation or claim progress to FivePoints:
Direct: +1.915.803.4198
If your plan names are Atlas America(ATA)/Student Secure(SS)/Patriot Exchange Program(PEP),above information is not suitable for use, please contact us for detailed claims guide.