Frequently Asked Questions
Claims
How do I file a claim?
Check your Summary Plan Document for specific information for your Health Plan. Your SIHO contracted provider should file your claim directly to SIHO. However, if it becomes necessary for you to file the claim yourself, send to SIHO, P.O. Box 1787, Columbus, IN 47202-1787. Click here for a Claim Form.
How long do I have to file a claim?
Typically submission of claims to the Plan Administrator (SIHO) should be filed within ninety (90) days after the services are rendered. Please check your Summary Plan Document for specific claims filing limits.
A provider has billed me, how do I know how much of the bill to pay?
Refer to your SIHO Explanation of Benefits. The Explanation of Benefits will indicate your responsibility for the bill. For more information, check your Summary Plan Document.
What is a deductible?
Deductible means the specific dollar amount of covered charges that must be incurred during a Calendar Year before any covered charges can be considered for payment by the Health Plan. Check your Schedule of Medical Benefits in your Summary Plan Document for specific plan amounts and more details regarding the definition.
What is a copayment or coinsurance?
A specific dollar or percentage of covered charges indicated in the Schedule of Benefits for which a covered person is responsible.
How does my out-of-pocket maximum work?
The out-of-pocket maximum is the dollar amount of a deductible and/or coinsurance expense paid by a covered person and/or family for covered services in a benefit period. After you reach your out-of-pocket limit, your plan covers 100% of the eligible charges for the remainder of the benefit period unless specified by your Health Plan. Check your Summary Plan Document for details.
What is Coordination of Benefits?
Your Summary Plan Document lists the definition in detail. Coordination of Benefits, or COB, applies when you are covered by multiple health benefit plans at the same time. Under one plan you will be designated as a primary member and benefits will be applied first. The second plan will coordinate with the first for any other possible payment.
Do I need to complete and return a Coordination of Benefits questionnaire?
You received this Coordination of Benefits questionnaire because we have missing or outdated information, this indicates you may be eligible for more than one insurance coverage. Please fill out the questionnaire and return to: SIHO COB Coordinator, P.O. Box 1787, Columbus, IN 47202-1787.
Appeals
Do I have the right to appeal a claim denial or claims payment?
Check your Summary Plan Document for specific information regarding your Appeal Rights and Procedures. Any appeals should be directed in writing to SIHO Appeals Coordinator, P.O. Box 1787, Columbus, IN 47202-1787.
Physicians and Other Providers
How do I find a SIHO Network Provider?
These providers may be found in the SIHO Provider Directory.
What is the advantage of using a SIHO Network Provider?
If you use a SIHO network provider, your provider will be responsible for filing the claim on your behalf and will directly receive payment from us for covered services. In most cases, you will only be responsible for deductibles, coinsurance or copayments. If you utilize a non-network provider, you may be subject to balance billing for any outstanding amount. Check your Summary Plan Document for more information and the SIHO Provider Directory for network providers.
How is my claim processed if I do not use a SIHO Network Provider?
If your Health Plan design requires you to utilize a SIHO Network Provider, your charges could be denied or require an increased amount of responsibility for your portion of the payment. Refer to your Summary Plan Document for more information.
What is a Primary Care Physician (PCP)?
Your PCP acts as your regular physician and can help coordinate other care you may need, such as a specialist office visit or hospital inpatient or outpatient services. Check the SIHO Provider Directory for a list of these PCP's.
How do I choose or change my Primary Care Physician (PCP)?
You can choose your PCP on your initial enrollment form. If you need to change your current PCP you can select your provider from the PCP listing, call a SIHO Member Services Representative at the phone number listed on the back of your card or contact us and make the necessary change with the effective date of the change. A new ID card will be issued with your PCP listed on the card. This is only applicable to the Health Plans who utilize PCP requirements. See your Summary Plan Document for details.
Can I utilize a non-network provider?
You can do so, but your claims could be denied or processed with out-of-network benefits, causing you to incur more out-of-pocket expenses. See your Summary Plan Document for details.
Miscellaneous
What do I do in case of an emergency?
Call 911 or seek medical help immediately to receive care. However, you should contact SIHO within 48 hours of going to the hospital to ensure the highest level of benefits are paid for covered services.
How do I order additional ID Cards?
Call SIHO Member Services to request an ID card, 812-378-7070 locally or 800-443-2980 outside of Bartholomew County.
Should I carry my ID card at all times?
Yes, you will be asked to present this card each time you visit a physician's office, pharmacy or hospital to verify eligibility for health benefits.
What does HIPAA actually do for me as a SIHO Member?
The HIPAA Privacy Rule has, for the first time, created national standards to protect individuals’ medical records and other personal health information. It sets boundaries on the use and release of health records and establishes appropriate safeguards for healthcare providers and others must achieve to protect the privacy of health information. The legislation sets limits on releasing health information to a minimum or reasonably needed purpose of disclosure. Also, HIPAA rules empower individuals to control certain uses and disclosures of their health information. HIPAA generally provides patients the right to examine, obtain and review a copy of their own health records and allows individuals to request corrections.
How to Read Your Explanation of Benefits (EOB)
Click HERE for a sample EOB with a detailed description of each section