Benefits & Claims

My doctor sent in a claim and I received a letter from the Culinary Health Fund asking questions about an accident.
What should I do?

The Culinary Health 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 Culinary Health 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 Culinary Health 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 Culinary Health 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 back to the Culinary Health 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 Culinary Health Fund may deny future care.

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

I went to the doctor and the Culinary Health 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 and what the Culinary Health Fund paid. The EOB may also tell you why the Culinary Health Fund didn’t pay for a service. If you have any questions on your EOB, you can call the Customer Service Office to receive more information. Please note that an EOB is not a bill.

My doctor is sending me bills for his services that I thought the Culinary Health Fund covered. What should I do?

You should call the Customer Service Office 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 the Customer Service Office can do research on the claim. You can also check if your claims have been paid by clicking here to login to our website.

I received a letter from the Culinary Health 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 the Customer Service Office 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 by clicking here or you can get it from the Customer Service Office. 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.

What are my medical benefits?

The Culinary Health Fund offers the best health plan in Nevada, providing medical, dental, prescriptions, hospital stays, home health, and even a life insurance benefit. To learn how your benefits work, click below:

How much are my copayments for a doctor visit?

Click for a list of common copayments for PPO care.

Is my doctor a PPO doctor?

Click here to view the PPO Directory.