Member FAQ

CLEARCHAIN HEALTH CONTACT INFORMATION

Member Support Team
833-733-8478

Pharmacy & Prescription
866-900-3711

TRANSITION TO CLEARCHAIN HEALTH PLAN

+ What happens to any old claims that have not been covered yet?

ClearChain will cover any claims that were not processed by your old plan for up to a year after the date of service. Your provider will need your new ClearChain Health information found on your ID Card so they can re-submit the claim to ClearChain.

+ Will I get credit for the deductible and out-of-pocket costs I already met prior to the transition to ClearChain Health?

Yes! You will get full credit for any deductible and out-of-pocket expenses you experienced during your previous health plan. We will work with your employer to assign a reset date for your deductible and out-of-pocket expenses. 

PROVIDERS

+ What if my provider has never heard of ClearChain Health?

This is a common point of confusion. ClearChain Health is not a network and will not be on your doctor’s list of participating programs.  Contact us immediately and we will reach out to make sure your provider is familiar with ClearChain Health and to ensure this is not a barrier to receiving care.

+ Why it MIGHT take longer to get your provider set up with ClearChain Health?

+ Are my doctors & medical providers in-network with ClearChain Health?

+ How do I find out if my provider already participates in ClearChain Health program?

Each provider directly participates on a patient-by-patient basis. Even if your provider participates in ClearChain Health for another member or patient, you will still need to nominate that provider on  your behalf by submitting this nomination form before your first visit. Link here.

+ How do I sign up my provider to participate in ClearChain Health?

Just complete and submit this provider nomination form. Our ClearChain Health Member Support team does the rest! Link here.

+ I submitted my nomination form, but my doctor’s office said my provider is not participating. What do I do?

Contact us immediately and we will reach out to make sure your provider is familiar with ClearChain Health and ready for your next visit.

+ My doctor’s office said ClearChain Health is not included in their list of providers?

This is a common point of confusion.  Anytime a member asks their doctor if they are in-network or accept ClearChain Health, the doctor’s office is correct in saying no.  ClearChain Health is not a network and will not be on your doctor’s list of participating programs.  Contact us immediately and we will reach out to make sure your provider is familiar with ClearChain Health and to ensure this is not a barrier to receiving care. 

+ What is a non-participating doctor?

A non-participating provider is one who does not agree to submit claims and accept payment through ClearChain Health.  In these situations, you have several options to move forward.  This occurs with 10% of providers nationally.

+ What happens if my provider refuses to participate?

90% of providers participate with ClearChain Health once they are in contact with our program, so your provider will most likely participate as well. If a provider refuses to participate, however, please contact us immediately so we can help!

A ClearChain Health Member Support team member will contact the provider or facility to

answer any questions and address concerns.
As a network-free insurance plan, ClearChain Health does not require contracts.  However, some providers or facilities require contracts on their end.  If this is the case, our provider access team will work with your provider to develop a solution for your care.  In most cases, the provider will acknowledge participation in the ClearChain Health plan and will accept the patient.

Like any insurance plan, however, sometimes providers or facilities simply do not participate. If this is the case, you are free to choose another provider or facility. Our Member Support team members can help you find a new provider based on your needs. Just give us a call and we’ll do the footwork for you!

PHARMACY + PRESCRIPTION

+ Will my medications be covered?

Some medications may require prior authorization approval before they are covered under your new plan.  You or your physician can contact ApproRx with any questions or concerns regarding the prior authorization process at 866-900-3711.

+ I’m having issues filling my prescription or have questions about my pharmacy and prescription benefits.

Our ClearChain Health Pharmacy Benefit Manager can help you.  Contact ClearChain Health’s Pharmacy Benefit Manager at 866-900-3711.

+ I need help understanding my prescription benefits or I have a claims question.

Call ClearChain Health’s Pharmacy Benefit Manager support team at 866-900-3711 and we will be happy to answer any questions and get you the help you need. 

BILLING, CLAIMS + REIMBURSEMENT

+ What Costs are my responsibility as a member?

1. You are responsible to pay your employee contribution out of your paycheck.
2. Co-pays at the time of visit if applicable.  Never pay additional amounts at the time of visit or before your visit.
3. Patient responsibility as listed on your EOB.  This included co-pays, deductible & co-insurance.

+ I’m getting bills directly from providers for more than what insurance paid.

You should only pay your deductible, co-insurance, co-pays, and out-of-pocket amounts on your ClearChain Health explanation of benefits (EOB). If providers are attempting to collect more, it may be a balance bill activity. Contact our Member Support team at (833) 733-8478 and we will answer your questions and help solve the issues you may be experiencing. Learn more about understanding your responsibilities. 

+ Where do I find my Patient Responsibility amount?

You can locate your Patient Responsibility on the Explanation of Benefits (EOB) sent to you by ClearChain Health. Please monitor your mail and forward any communication that appears to be collection efforts by the provider or hospital in excess of the Patient Responsibility identified in your EOB. ClearChain Health is happy to assist you in interpreting any invoice you receive from a provider or hospital. Learn more about how to read your EOB on Understanding Your Responsibilities.

+ What should I do if I get a bill from my provider that is more than what my EOB says?

Contact our Member Support team immediately at (833) 733-8478 and we will help. Read Understanding Your Responsibilities to learn more. Link to Understanding your Responsibilities page.

+ What happens if there is a dispute about the difference owed?

In the event there is a dispute following payment, ClearChain Health will work directly with the facility or provider to understand their position and resolve this matter. We will defend you and your plan against unfounded collection activity. You are not responsible for the amount in excess of your patient responsibility. You are protected by state and federal debt collection laws. In the event a member experiences a violation of these laws, ClearChain Health will provide the necessary defense and guidance. 

+ Do I have to submit my own claims?

As with most health care plans, your provider will likely submit your health claims. However, there are some providers that do not submit claims, regardless of the health plan. In these cases, we make it easy and fast to submit your claims, check on the status and assist you throughout the process. If your provider’s policy is for the patient to submit claims, simply login to your Member Portal to submit a claim.

CLEARCHAIN HEALTH PORTAL

+ How do I request a new ID Card?

Click on the View/Print an ID Card menu link inside the ClearChain Health Portal. You can either print a temporary ID card or you can submit a request to ClearChain Health for a permanent ID card. If this option is not available on your screen, please contact your ClearChain Health for additional information.

+ Why isn’t my new temporary ID card printing?

Your browser may not allow pop-ups. Check your browser settings to ensure that pop-ups are enabled. If this option is not available on your screen, please contact ClearChain Health for additional information.

+ How do I add my new baby to my policy?

Click on the Status Change menu link inside the ClearChain Health Portal. Select a Change Reason and check the Add Dependents box. After you have submitted your request to ClearChain Health, we will process your request according to your plan’s policy. If this option is not available on your screen, please contact ClearChain Health for additional information.

+ Why can’t I access my spouse’s information?

Employees must be granted PHI access to spouses and dependents over 18. If you see your spouse or adult child listed in the Your Dependents panel on your Home page but are unable to click the Select button to view them, please contact ClearChain Health for additional information.

We’re excited that members are going to have excellent access to health care at reduced costs. If you have any questions or any concerns with the program we’re available. Call your member support line at 833-733-8478 and let us know how we can help.

MEMBER PORTAL

+ Where do I find my Explanation of Benefits?

They would click on Claims.

+How do I see how much of my deductible and out-of-pocket amounts have been met to date?

The member would login and click on deductibles.