How to File an Insurance Claim as an International Student

As an international student, we understand that when purchasing insurance, one of your main concerns is ensuring that your plan will cover in the event you need it. As with all things in the U.S. healthcare system, getting your benefits paid after visiting a medical provider can sometimes be a complicated process.

In this article, we aim to help you understand more about the process of filing a claim and ensure you get the coverage you’re entitled to through your insurance benefits.

What is a Health Insurance Claim?

A claim is a request for payment that you or your healthcare provider will submit to your health insurance when you incur medical expenses.

A claim should include general information on the charges, as well as information about the nature of the visit based the information the doctor determines during the visit. After this, the insurance will determine coverage, send the provider any payments they are responsible for and the provider will bill you for the total amount you are responsible for.

Do I Have to File a Claim On My Own?

You will typically not need to submit a claim on your own, as a majority of US insurances (including all ISO plans) are not reimbursement plans. Reimbursement plans require members to pay out of pocket at the time of service and submit a claim on their own to be reimbursed by the insurance. Make sure to review your plan details prior to purchase to clarify how claims work.

If you do not have a reimbursement plan, then providers should directly bill your insurance instead of charging the full amount. However, it should be noted that providers will often charge you partially at the time of visit. In particular, you should be aware of your plan’s copay amounts as this is what will typically be charged during the visit.

How Do I File a Claim?

In rare circumstances, you may see a provider who requires you to pay out of pocket in full for your services. This will often be the case if you visit a non-participating/out-of-network provider.

Although this might sound alarming, there is no need to panic. Submitting a claim on your own will generally not be a difficult process (especially for ISO members).

Here is the protocol for filing a claim as an ISO member:

1. Check with your doctor: Before or during your appointment, make sure you provide the medical provider your insurance ID card. This card will have all the information needed for the provider to submit a claim on your behalf, including the claims department’s address and payer ID. Sometime while you’re there, make sure to confirm with the provider whether or not they will be submitting a claim on your behalf. If not, follow the next couple steps.
2. Get all claim documents: If your doctor will not file a claim for you, you’ll need to gather some information to file on your own. You will definitely need a payment receipt (if paid up front for your visit) and an itemized bill – which must include the name of the doctor or clinic, date of service, diagnosis code, procedure code, provider tax ID, and total charge of the service.
3. Complete a claim form: In addition, you must fill out the following claim form to provide additional information on the expenses.
4. Submit form and documents: Gather your completed claim form and documents and send to our claims department Sisco Benefits via one of following methods:
   • Via your claims portal – go to “My Claims” on your ISO account page and access the “Claim Submission” tab.
   • Via email – send all documents to ISOService@siscobenefits.com
   • Via mail – can mail all documents to Sisco Benefits – PO Box 3190, Dubuque, IA 52004

How Long Does It Take for Claims to Be Processed?

Claims are typically processed within 30-40 business days. Once your claim has been processed you will receive an explanation of benefits (EOB); an EOB is a statement from your health insurance company that describes in detail how you were covered according to your plan’s benefits for the medical services that you received.

EOBs will generally be mailed to you so make sure your address is always up to date in your insurance account. Insurance companies may require additional information to process claims, which will generally be noted in the initial EOB. For more information on how to understand your EOB, see this blog post.

My Claim was Processed Incorrectly, What Now?

If you receive your Explanation of Benefits and believe an error was made, you do have the option to appeal the decision. However, we always suggest contacting your insurance or claims department to get an explanation on what went into the decision, as well as making sure to review your plan details (in particular the exclusions) before the visit to avoid any surprises.

For ISO members, if you would like to submit an appeal, you can send your request to ISOservice@siscobenefits.com. In this request, make sure to include an appeal form and provide a detailed explanation as to why you believe the denial should be overturned, and any documentation that can support your claim.

For any questions on appeals or other claims questions, Sisco can be reached at 833-577-2586 or you can contact ISO at 212-262-8922.

If you’re looking for insurance with reliable claims processing, check out ISO's affordable plan options – offered to all US visa statuses!