Claims Resource Center

Frequently Asked Questions

The “Claimant’s Statement and Authorization” form is a document that we request upon receipt of a claim for a new medical condition or episode of care. Your submission of a thoroughly completed “Claimant’s Statement and Authorization” form provides us with information so that we can properly evaluate whether the claim is eligible under your policy.

This form also allows us to request medical records from your medical providers.

The AUTHORIZATION FORM FOR USE AND/OR DISCLOSURE OF PROTECTED HEALTH INFORMATION (HIPAA) gives Tokio Marine HCC – MIS Group permission to disclose and release Protected Health Information (PHI) to anyone specified on the form.

We require that the AUTHORIZATION FORM FOR USE AND/OR DISCLOSURE OF PROTECTED HEALTH INFORMATION (HIPAA) is signed and thoroughly completed if you wish for your PHI to be disclosed and/or released to a specified person. You may complete and submit the form via DocuSign by visiting ClientZone or to download and print the form, click here.

For each claim received, we will send you an acknowledgement letter notifying you of our receipt of your claim. The acknowledgement letter will also notify you of any additional information that is needed or is still outstanding from a prior request.

Additionally, each time we request information from your or your medical providers, we will send you a letter to notify you of the request.

We require a completed “Claimant’s Statement and Authorization” form for each different condition or episode of care. Therefore, if you have completed a “Claimant’s Statement and Authorization” form for a particular episode of care, you do not need to resubmit.

However, if you received treatment for a different condition or episode of care, you will need to complete a new “Claimant’s Statement and Authorization” form.

While we may have received a completed “Claimant’s Statement and Authorization” form from you, we may be waiting on medical records from your providers. Each time we request additional information, you will receive a letter notifying you of what is being requested.

You may assist us with these requests by contacting the medical provider to request that the medical records be expedited to us.

See More Claims Related Questions

Our policies are not subject to the Patient Protection Affordable Care Act. They do not contain many of the coverages required by PPACA and therefore may contain a pre-existing condition exclusion.

You are always free to use the medical providers of your choice. However, depending on your plan, you may have a higher coinsurance responsibility if you visit an out-of-network provider in the U.S.

Refer to the “Schedule of Benefits and Limits” in the Description of Coverage for your plan to determine your coinsurance responsibility for in-network and out-of-network payments.

Note that we use the First Health Network as our provider network within the United States. You may search for in-network providers here.

Our World Service Center offers emergency assistance and referrals 24 hours a day, 7 days a week. Please contact us at 1-800-605-2282 and a representative will be available to assist you. We also accept collect calls from anywhere in the world at 1-317-262-2132 or if you are traveling in a country outside of the United States, search here for a list of Worldwide Toll-Free Numbers.

Many providers are willing to bill us directly, and we are happy to work directly with the provider. The provider should submit to us original itemized bills. You, the patient, will still need to submit to us a completed “Claimant’s Statement and Authorization” form.

If the provider does not accept an upfront payment, it’s important that you obtain an itemized bill that contains diagnosis and/or procedure information and send it directly to us, along with a completed “Claimant's Statement and Authorization” form.

Note: For plans that offer a coinsurance waiver for expenses incurred in-network, the provider must bill expenses directly to us.

Please email all claim related documents to [email protected] or by mail:

Tokio Marine HCC – MIS Group
Claims Department
Box No. 2005
Farmington Hills, MI 48333-2005
U.S.A.

You may complete and submit a “Claimant's Statement and Authorization” form electronically by logging into ClientZone. If you do not have access to the internet, please feel free to contact us so that we may send a form to you by fax or mail.

No, you should submit one “Claimant's Statement and Authorization” form to us for each different condition.

Yes. We can define the benefits that are available within your coverage. However, we cannot pre-approve any treatment or guarantee payment in advance.

Once you have signed and submitted your Claimant’s Statement and Authorization form, our claim’s examiners will review your information typically within 30 days of the receipt of the claim.

The initial review of your claim will determine whether it will be paid, denied, or if more information is needed to make a final decision. We may request more information of you or your medical providers before your claim is paid or denied.

Final processing time of your claim is dependent upon multiple factors. However, you can assist us in reducing your claim pending time by ensuring that we receive all requested information timely and quickly.

To check your claim status, please visit ClientZone at https://zone.hccmis.com/clientzone, email your inquiry to [email protected], or contact us at 800-605-2282.

The EOB is not a bill. Rather, it is an explanation of how your claim has been processed.

You may ask us to reconsider the denial by visiting https://service.hccmis.com to complete and submit a Claimant Appeal Request form along with uploading up to five supported documents. You may also download and print the form here to mail in. In order for our claims department to review the appeal, you must provide additional documentation or information to support a reversal of the denial.

You may send all claim related documents via email at [email protected], by visiting our customer service center online at https://service.hccmis.com to upload documents, or send by mail to:

Tokio Marine HCC – MIS Group
Claims Department
Box No. 2005
Farmington Hills, MI 48333-2005
U.S.A.
See Fewer Questions

Understanding the Claims Process

How to File a Claim Outside the United States

Follow Michelle’s journey through the claims process to understand what happens if you receive medical care outside the United States.


How the Claims Process Works in the United States

If you received medical care within the United States, watch the video and follow along with Will to learn how the claims process works.

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  • Copayments (Copays) — the fixed amount the insured person must pay out of pocket for specific medical services. Generally co-pays pertain to general health care services, such as general office visits. Some plans require that the insured pay the full amount for all medical services, including general doctor’s visits, until the deductible has been met.
  • Claimant — a person or entity making a claim under a policy.
  • Claimant Statement — an authorization form completed by the claimant, then submitted to the insurer.
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  • Deductibles — an amount that must be met, usually over the course a certificate period, in order for the insurance plan to cover specific medical expenses.
  • Date of Service — the date that a medical service was received. This date may differ from the date that the medical claim is filed with the insurance company.
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  • In Network — refers to physicians and medical facilities who are under contract with First Health Network (US) or Equian International Provider Network (outside US) and provide medical services at a discounted rate.
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  • Out of Pocket — an amount determined in the medical insurance plan as the amount the insured must pay, in addition to premiums, for health care services.

    A maximum amount is usually assigned per policy. Once the maximum is met, the insurer will pay a percentage – sometimes up to 100 percent – of the insured’s eligible health care costs.

  • Out of Network — Physicians and medical facilities who are under contract with First Health Network (US) or Equian International Provider Network (outside US) and thus charge the full rate for their services.
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