FAQ

Have additional questions?
Reach out to us by calling (800) 777-9087 or emailing us at [email protected].

Employers

How can I contact Med-Pay?

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

How can I access information about my plan?

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.

Who can I contact with questions about eligibility, adding a new employee, or terminating an employee from my plan?

For any questions regarding eligibility, you can reach out directly to our eligibility team by phone or email.

How can I have a provider added to the PPO?

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.

Members

How can I contact Med-Pay?

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.

How can I get a copy of my Plan Document?

The Plan Document is available through your employer's human resources department.

Who can be covered under my policy and how do I add someone to my plan?

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.

What if I, or my dependents, have other coverage?

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:

  • Medicare, either due to age or disability
  • Group coverage through the employment of another family member
  • Association group coverage through an organization you or a family member belong to
  • Student health insurance covering dependent children
  • Coverage mandated by a divorce decree, requiring a divorced spouse to carry coverage on certain dependent children

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:

  • The name, address, phone number, and policy number of the other insurance company or plan
  • In the case of group or employer coverage, the name of the group or employer
  • The name and birthdate of the person who is listed on the coverage as the primary member or policyholder
  • The effective date of the coverage
  • The type of coverage, such as medical or dental
  • The names of the family members covered under the plan
  • A copy of the ID card, if available

See the Contact Us section for mail and fax information.

How do I change my address?

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.

How can I correct information that Med-Pay has on file, such as the spelling of my name, my address, or date of birth?

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.

I recently enrolled for coverage with my employer. How long will it take to receive my ID card?

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.

How can I obtain a copy of my ID card?

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.

Who should I call if I have a question on my plan's benefits or on a claim?

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.

How can I get a copy of my Explanation of Benefits (EOB)?

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.

What is pre-certification for inpatient hospital care?

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.

What is a preferred provider, and how does using one affect my benefits?

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.

Do I need to file a claim?  

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.

What if I have an accident and have to have medical treatment?

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.

What if I have expenses for an accident or illness that may be payable by worker’s compensation insurance, car insurance, or another third party?

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.

What is a Pharmacy Benefit Manager (PBM)

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.

If my pharmacist has a problem processing my prescription, what should I do?

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.

Brokers

I'm new to self-funding, can Med-Pay help me better understand how self-funding works and why it might be a good option for my clients?

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 [email protected].

Why choose Med-Pay over other TPAs?

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.

Can Med-Pay support me in renewal discussions with clients?

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.

Does Med-Pay work with brokers to deliver self-funded healthcare options to employers?

Yes- Med-Pay feels strongly in offering design and administration of self-funded healthcare plans together with a client's broker.

How can I get in touch with Med-Pay?

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 [email protected] or to our sales team at [email protected].

Providers

How can I obtain a patient's eligibility and benefit information?

Please contact Med-Pay customer service.

Explore

Resources