If you have specific questions about your plan, you can always reach out directly to your dedicated account services team, our customer service team, or a specific department. Departmental emails are listed on the contact us page, and general contact information is included below.
Mail:
Med-Pay
1650 E Battlefield Rd #300
Springfield, MO 65804
OR
PO Box 10909
Springfield, MO 65808
Contact Customer Service:
Main Line: 417-886-6886
Toll Free: 800-777-9087
Fax: 417-890-0741
UR Fax: 417-886-7679
Customer Service Hours:
Mon. - Thur. 8:30 am – 4:30 pm CT
Fri. 8:30 am - 4:00 pm CT
You can always reach out to your dedicated account services team or our customer service team to discuss specific questions. Or if you prefer, our Employer portal provides access to claims and member information. To access the employer portal, contact your account representative. Once you have been set-up with an account, you can view member demographics and claim information. You can also submit questions through the portal on a member or a specific claim.
For any questions regarding eligibility, you can reach out directly to our eligibility team by phone or email.
Ask the provider to contact the PPO directly. The PPO will screen the provider based on their credentialing criteria and negotiate rate terms. Please contact your account services team for more information.
Mail:
Med-Pay
1650 E Battlefield Rd #300
Springfield, MO 65804
OR
PO Box 10909
Springfield, MO 65808
Contact Customer Service:
Main Line: 417-886-6886
Toll Free: 800-777-9087
Fax: 417-890-0741
UR Fax: 417-886-7679
Customer Service Hours:
Mon. - Thurs. 8:30 am – 4:30 pm CT
Fri. 8:30 am - 4:00 pm CT
When faxing information, please retain a copy of the confirmation record which displays the date, time, and phone number from where you faxed the information. Our customer service team will need this information if you call later to confirm receipt.
The Plan Document is available through your employer's human resources department.
Eligible dependents are defined by your group health plan. Details can be found in your plan document. You may also contact your human resources department for eligibility information and requirements for enrolling dependents.
You can add a dependent to your policy during the annual enrollment period or within a certain number of days of a qualifying life event, as outlined in your plan document.
If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll the dependent for coverage provided the request for enrollment is received within the number of days specified in your plan document. To submit a change to your enrollment contact your human resources department.
Most health and dental plans contain a coordination of benefits provision. This means that if one person is covered by two or more benefit plans, the plans contain provisions that will determine the order that the plans pay, i.e. which plan pays first or primary and which plan pays second and third, etc.
Med-Pay periodically requests updated information regarding other coverage you and your family members have. However, if at any time, you or a family member becomes covered under another policy, you should notify Med-Pay as soon as possible.
Examples of other coverage are:
Additional coverage information should be submitted during the enrollment period. If other health insurance is obtained outside the enrollment period, please mail or fax to our Customer Service department and include:
See the Contact Us section for mail and fax information.
If you are a current employee, address changes must be submitted through your human resources department. If you are a COBRA or retiree participant, please contact our Customer Service department.
Med-Pay can only accept eligibility changes from your employer. Please contact your human resources department to update your information. They will then provide the corrected information to Med-Pay. If the incorrect information is causing immediate issues, please contact the Med-Pay customer service team and they will work with your human resources department to update the information.
Once your enrollment form has been completed and submitted to Med-Pay, you should receive your ID card within 7-10 business days. If you need your coverage information prior to receiving your card, please contact our customer service team.
Sign into your member portal and look for the link that says, "Print my ID card". You can then print or download your ID card.
You can also request a new physical ID card on the portal by using the "Request an ID Card" link.
If you are unable to access the member portal, please contact our customer service team and they can provide assistance.
We know health care benefits can be confusing, which is why our customer service team is available to help you and your provider get the answers you need. You or your provider can call the Med-Pay customer service team by phone (417-886-6886 or 800-777-9087), or you can use the member portal which has links on each tab to submit general questions, benefit questions, or questions on a specific claim.
Explanation of Benefits are always mailed to the address we have on file and will also be sent to your provider. If you need a copy, you can use the member portal to view and print the EOB. Once logged into your member portal, use the "Claims" section to navigate to the applicable charges claim. You can use the "Filter" feature to view a specific date of service. When you find the claim, click on that Claim Number to view a summary EOB on your screen. You can also click on the "View Your Original EOB" link to view a copy of the original EOB that was generated.
Pre-certification is a part of the utilization review process; it is designed to ensure that patients received quality care that is medically necessary and appropriate for their condition. More details of the specific requirements associated with pre-certification can be found in your plan document. The phone number for pre-certification can be found on your ID card.
Preferred providers are providers who have contracted with a network that is offering discount arrangements to your employer. These providers are considered in-network providers and benefits are paid at the higher benefit level. Since changes in network participation can occur and additional plan provisions may apply if you are outside your employer's core area, it is important to verify that your health care provider is a current participant prior to receiving medical services. Verification can be obtained by contacting the network directly. You can also use the member portal and go to the 'Coverage and Benefit' page where there are links to the PPO networks. Our customer service team is always available to assist as well.
Normally your healthcare provider will file a claim on your behalf. The appropriate mailing address is indicated on the back of your ID card, which should always be shown to your provider at the time of service. Your provider will then submit the required information to us on a standard form for processing.
If you had to pay for the service in full and need to submit the claim for processing yourself, contact the Med-Pay customer service team and request a "Health Claim" form. This form will need to be completed and included with the claim. See the "Contact Us" section for mailing and fax information.
If Med-Pay receives claims which indicate an accident, or any type of injury, you will receive a questionnaire which has detailed questions concerning the accident. This must be completed and returned to Med-Pay. Additional information may be required once this is received and reviewed for third party liability.
Your health plan may have a right to recover payment made on your medical bills if they were incurred for an injury or condition caused by another party. This right falls under the subrogation and reimbursement provision of your coverage. If we pay benefits as a result of an injury or illness that was caused by another party, we have the right on behalf of the plan to pursue recovery from the party responsible for your injury or illness for benefits the plan has paid. Under certain circumstances, the plan may also be entitled to be reimbursed for the benefits it has paid from the proceeds of a settlement or a judgment you receive from the party responsible for your illness or injury.
More commonly known as your prescription drug vendor, a PBM contracts with independent pharmacies or a chain of pharmacies to provide prescription medicines at a discounted rate for retail and mail order prescriptions. Your PBM name and phone number is located on your ID card. In addition, you can find out more information about your PBM by going to the home page of the Med-Pay member portal and clicking on the link for the PBM.
First, ask your pharmacist to contact the pharmacy help desk for the Pharmacy Benefit Manager (PBM) at the number listed on your ID card for assistance. If your pharmacist will not make the call, you may contact the pharmacy help desk directly.
If the prescription is not covered, the PBM will provide details of the denial. If your PBM indicates that the prescription requires pre-approval (or authorization), your doctor may need to provide additional information to the PBM. If so, ask your doctor to contact the PBM at the number on your ID card.
Yes - we believe in the value that self-funding brings to clients and are always eager to help our broker partners be in the best position to offer their clients solutions that will work for them over the long-term. If you're new to self-funding you can reach out directly to our President, Marshall Kinne, or by contacting our Sales Department at sales@med-pay.com.
We're constantly evolving to meet the needs of our clients. Our localized expertise, in-house offerings, and excellent customer service help drive strong value resulting in high client retention.
Yes - we know self-funding can be confusing, especially for first-time clients. We're here to help educate clients and co-sell with brokers as requested.
Yes- Med-Pay feels strongly in offering design and administration of self-funded healthcare plans together with a client's broker.
If you're new to Med-Pay and the services we offer to clients who are self-funded or are considering self-funding, we'd love to connect to share what makes us unique among other TPAs. You can either reach out via our customer service team at medpaycs@med-pay.com or to our sales team at sales@med-pay.com.
Please contact Med-Pay customer service.
