Pages Navigation Menu

Health Insurance Frequently Asked Questions – Michigan

Click on a topic below for answers to the most frequently asked questions.

Claim Information

Q. My claims are the result of an accident. Do you need special information to process my claims?

A. If you have an accident, we need to know how, when, and where the injury occurred. We also need to know if there is another insurance policy that might cover this claim, such as an auto, workers compensation, or homeowners policy Complete the accident form (LG199) and fax it to our office at 309-346-8265.

Q. How do I file my claims?

A. Your doctor or hospital normally will submit your claims to us for you. You will not need to do anything as long as you have provided them with your health insurance identification card at the time you received the service.

Drug claims are submitted by using your drug card when you purchase prescriptions. Your participating pharmacist electronically files the claim with the drug card company. If you do not have your drug card with you when you purchase a drug, you will need to get your drug card information to the pharmacy where you purchased the medication within 7 days of purchasing the medication so that the claim can be filed.

Q. Do I need to pre-certify or receive prior approval for any services?

A. You are only required to pre-certify an overnight stay in a hospital. You can do this by calling MCM’s pre-certification line at 800-245-3005. You should pre-certify a scheduled stay at least 48 hours before admission to avoid a penalty and to confirm your stay is approved. For emergency admissions, you must call the pre-certification line within two business days after admission.

Calling the pre-certification number does not confirm health care coverage for your stay or that the provider is a PPO provider. It simply establishes if the length of the overnight stay in the hospital is medically appropriate.

You will need to receive prior approval before purchasing or renting any medical equipment. You can do this by contacting our case management nurse at 800-371-9622, Extension 2782. The nurse will refer you to a cost-effective vendor if the item is a covered expense under your health insurance policy.

You will also need prior approval for any injectable medications other than insulin. You should call 800-371-9622, Extension 2782, for a vendor for these items.

Medicare Supplement Insurance

Q: What is a Medicare Supplement plan?

A:  Medicare Supplement insurance plans help cover the health care costs that are left unpaid after Medicare Parts A and B pay their portions of your health care costs. Medicare Supplement policies pay only for services Medicare considers medically necessary. Payments are generally based on the Medicare-approved charge. The policy might not fully cover all of your health care costs.

Medicare Supplement policies are available from private health insurance companies. While the costs of these policies may vary, individual health insurance companies must provide the same standardized benefits.

Q: Am I eligible to purchase a Medicare Supplement plan?

A:  If you’re enrolled in Medicare Part A and Part B, you’re probably eligible to buy a Medicare Supplement policy. During your Medicare Supplement Open Enrollment Period, which starts the first day of the month that you are both 65 or older and are enrolled in Medicare Part B and extends for six months after you sign up for Medicare Part B, a health insurance company must allow you to buy any Medicare Supplement plan offered. In some states these plans may be available to those under age 65 who are in an Open Enrollment period.

Q: Do I have to use certain doctors with my Pekin Life Insurance Company Medicare Supplement Plan?

A:  No. With a Medicare Supplement plan, you have the flexibility to choose any doctor or hospital that accepts Medicare.

This policy has exclusions and limitations. For cost and complete details of coverage, contact your Pekin Life Insurance Company agent.

Not connected with or endorsed by the U.S. government or the federal Medicare program. The purpose of this communication is the solicitation of insurance. Respondents will be contacted by a Pekin Life Insurance Company agent.

Form #: LZ400 MI  (updated 10/2016) (Advertisement)

Call Toll-Free 1-800-322-0160