BSSI Assistance

The following information is provided to assist you in using your Health and Dental Care Plan.

Customer Service – 1-800-423-1841

Our hours are 7:30 a.m. to 4:30 p.m., Central Time, Monday through Friday. Press 4 on your touch tone phone as soon as the Auto-Attendant answers, and you will be connected with the Claim Department (Press 6 for the Pre-tax Flexible Spending Account Department). Voice Mail is available outside of normal customer service hours, and we will return your call not later than the next business day.

If you have an ongoing complex claim issue, you can work with the same Benefit Analyst; Press 0 as soon as the Auto-Attendant answers and ask for her or him by name. Otherwise, all of our Benefit Analyst/Customer Service Representatives have immediate access to the claims for you and your family. They have specific information about the District 204 benefits and provide prompt and thorough responses.

BSSI will help if you have problems: For example, balance billing from a provider or confusion because you or a dependent has double-coverage problems. Please contact us if we can help.

The Claim Department should be able to answer any questions or need for assistance. However, if you are not satisfied with the help you received, please contact Irene Ormond, Benefit Manager (Ext. 327) or Amy Hartigan, Director of Benefit Administration (Ext. 301). Please give Irene or Amy the name of the Benefit Analyst and/or other BSSI person with whom you spoke to help them address your concerns.

Note: If you have questions about the Prescription Drug Program, you can contact Serv-U directly at 1-800-759-3203. A list of the national drug chains that are in the Serv-U network is attached; if you or a dependent is out of the area and need a prescription drug, you can use the Serv-U card at these pharmacies.

No Claim Forms Required

The use of the claim form provided by BSSI is optional. Doctors and Hospitals use forms that will provide the information BSSI needs for most claims; therefore, you do not need to send the claim form. Also, you do not need to send a claim form when you send bills directly to BSSI as long as your name, the patient’s name, and your employer’s name are shown on the bill. If we do not have enough information when we receive your claim, we will contact either your physician or you for the information. The claim form/pre-addressed envelope provided by BSSI is for your convenience in submitting claim information. If the claim is for an accident or your double-coverage situation has changed, providing the claim form can speed up the processing of your bills because we will not have to write back to you requesting information.

Pre-Treatment Request

If you or a dependent are planning treatment, you can complete the form to find out in advance if the fee may exceed your plan’s reasonable and customary allowance or, possibly, if there are questions concerning medical necessity.

You can also get a pre-treatment estimate of Dental benefits. Your Dentist should havea standard American Dental Association form that can be completed and sent to us.

Confirming Coverage Status

To make sure we pay claims correctly based on plan requirements, we may request the following information at the time a claim is received:

• the spouse’s employer’s name and address to confirm that our information on other group insurance is current. This request will be made once each calendar year, or sooner if your spouse changes employers.
• after the dependent’s 19^th birthday and prior to age 23, the full-time student status each semester. If you have a copy of the school registration form showing full-time student status, please submit it to us. BSSI can request this information from the college if you supply the name and address of the school along with the student’s social security number. Some colleges will charge the parents for providing this information.
• A copy of a divorce decree to confirm which parent has responsibility for coverage.

PPO Providers:

Based on the contracts between the PPO and the hospitals and physicians that participate in the network, BSSI is required to pay benefits to the provider when you or a dependent use their services; in other words your Plan benefits are automatically assigned to the hospital or physician.

A PPO provider should not balance bill you for the PPO discount.