How to File an Insurance Claim as an International Student

As an international student, one of the main concerns when purchasing insurance is ensuring that you’ll be covered when you need it. Navigating the U.S. healthcare system can be complicated, especially when it comes to filing claims after visiting a medical provider. We have prepared a guide to better help you understand the claim process and how to file a claim after a visit.

In this article, we aim to help you understand more about the process of filing a claim and ensure you get the coverage you’re entitled to through your insurance benefits.

What is a Health Insurance Claim?

A health insurance claim is a formal request for payment submitted to your insurance company after you incur medical expenses. This request typically comes from your healthcare provider, who includes information on the charges and the reason for your visit. Once the insurance company processes the claim, they determine the amount covered under your plan, pay the provider, and the provider then bills you for any remaining balance.

Do I Need to File a Claim On My Own?

In most cases, you won’t need to file a claim yourself. Many U.S. health insurance plans, including all ISO plans are not reimbursement plans. This means the provider will bill directly to the claims department rather than asking you to pay upfront for the full amount. However, you should always review your plan details to understand how claims are handled.

For non-reimbursement plans, you may still need to pay some costs at the time of your visit, like copays. Be aware of your plan’s copay amounts, as this is what you’ll usually be charged during your appointment. You can refer to the insurance ID card or the plan brochure for more information.

How Do I File a Claim?

In rare cases, you may visit a provider who asks you to pay the full amount upfront, especially if they are an out-of-network provider. While this might seem concerning, filing a claim yourself can be straightforward, especially for ISO members.

Here’s how you can file a claim as an ISO member:

1. Confirm with your provider: At the time of your visit, present your insurance ID card. This card includes all the necessary information for your provider to submit a claim, such as the claims department’s address and payer ID. Be sure to ask your provider if they will be submitting a claim on your behalf. If not, follow the next steps.
2. Get all claim documents: If you need to file the claim yourself, collect important documents, including a payment receipt (if you paid upfront) and an itemized bill. The itemized bill should list the doctor or clinic name, date of service, diagnosis code, procedure code, provider tax ID, and the total charge.
3. Complete the claim form: Download and fill out the claim form to provide additional details about your expenses. This step helps clarify the reason for your visit and any treatments you received.
4. Submit your claim: Once you’ve completed the form and fathered the required documents, send them to Sisco Benefits, ISO’s claims department. You can submit via:
   • Your claims portal: Log into your ISO account and navigate to the “My Claims” section, then go to “Claim Submission.”
   • Email: Send your claim form and documents to ISOService@siscobenefits.com
   • Mail: Mail the documents to Sisco Benefits – PO Box 3190, Dubuque, IA 52004

How Long Does It Take to Process a Claim?

Typically, claims are processed within 30 business days. Once processed, you’ll receive an Explanation of Benefits (EOB), which details how your insurance plan covered the services you received. Make sure your mailing address is always up to date in your insurance account, as EOBs are sent by mail to your physical address.

If your claim requires additional information, it will be noted in the EOB. For more details on understanding your EOB, check out our dedicated blog post.

What to Do If Your Claim Is Processed Incorrectly

If you believe your claim was processed incorrectly, don’t worry. You have the option to appeal the decision. However, we recommend first contacting your insurance or claims department to clarify how the decision was made. Make sure to always review your plan’s details, especially exclusions, before any medical visits to avoid surprises.

For ISO members, if you’d like to submit an appeal, you can send your request to ISOservice@siscobenefits.com. Be sure to include the appeal form, a detailed explanation of why you believe the denial should be overturned, and any supporting documentation.

For any questions regarding appeals or claims, you can contact the claims department, Sisco Benefits at 833-577-2586 or send an email to ISOservice@siscobenefits.com.

At ISO, we offer a range of affordable insurance plans designed to provide reliable coverage for international students. Our plans include direct billing claims processing, top of the class customer service and comprehensive coverage offered at an affordable rate.