My doctor sent in a claim and I got a letter from the Fund asking questions about an accident.  What should I do?
The Fund will request additional information if it looks like you were injured in an accident or if someone else might have caused your injury.  You should answer the questions in the letter and send it back to the Fund.  Payment of the claim will be delayed or denied if you don't mail the letter back, and you may receive a bill from the provider.

I was in an accident and the Fund sent me paperwork - what is it and what should I do?
If another person or organization is responsible for your accident, like another driver, the Fund wants to make sure the person or company pays what they should. Complete and sign this paperwork so that we can pay for your care and get repaid if someone else is responsible.  Here's what you should do:

• Fill out and sign the papers.
• If you have a lawyer, have them complete the forms also. 
• Send all completed papers to the Fund.
• If you are involved in a lawsuit and reach a settlement, make sure your settlement includes the future cost of your health care needs related to the injury. Once you sign for a settlement, the Fund may deny future care.

If you don't complete and send the papers back to the Fund, the Fund will not pay the claims and you may have to pay for your medical care.

I went to the doctor and the Fund sent me an "Explanation of Benefits".  What is this and do I need to do anything?
An Explanation of Benefits (EOB) tells you what the doctor charged, what the Fund paid.  The EOB may also tell you why the Fund didn't pay for a service.  If you have any questions on your EOB, you can call Customer Service to get more information.

My doctor is sending me bills for his services that I thought Culinary covered.  What should I do?
You should call Customer Service to ask if the doctor sent a claim in and if it was paid.  If it was denied, ask the representative to explain why. When you call, you should have the date of service and amount of the bill so that Customer Service can do research on the claim. You can also check if your claims have been paid on our website by clicking here.

I got a letter from the Fund saying that more information is needed before my claim can be paid.  What should I do?
The letter should tell you what is needed and who needs to send it in.  If your doctor needs to send more information, you can call them and make sure they send the information.  If you need to send something in, and it isn't clear what is needed, you can call Customer Service to ask for more information.

My claim was denied and I think it should have been paid.  How can I appeal this decision?
You can submit an appeal form telling why you think the claim should be paid.  An appeal form is available here or you can get it from Customer Service.  Be sure to include your name and social security number, the patient's name, the date of service, the provider's name in your statement, and any other information you have that you think will help us understand your problem.   You must send in your appeal within 12 months from the date your claim was denied.