What is a Third Party Administrator?
TPAs offer administrative and consulting services to health benefit programs for large employers. Services include claims processing for all group benefits including medical, dental and prescription drug plans.

How are claims processed?
At Health Plans, Inc., claims examiners are assigned responsibility for specific clients, and at the same time they serve as part of a claim team that provides mutual support and services at all times.

Do I need to complete a claim form?
No, claim forms are not required. Most physicians will submit a claim using an industry standard claim form.

Who do I call to inquire if a certain service is covered or when I can expect payment of a claim?
You should contact Health Plans, Inc. at 1-800-343-7674. Health Plans, Inc. business hours are 8:30 a.m. to 5:00 p.m. EST Monday through Friday.

When calling, please have your group number ready.

What should I do if I receive a bill from a provider at home?
Do not discard any bills you receive at home. While most providers do invoice Health Plans, Inc. directly, some providers like laboratories and radiology facilities do not have access to your health coverage information and send the bill directly to you. You should forward these bills to:

Health Plans, Inc.
P.O. Box 5199
Westborough, MA 01581

If I submit a claim to Health Plans, Inc., how long should I expect to wait for payment?
If all information is included with the bill, you can expect payment within approximately thirty (30) days of receipt.

How do I determine if a provider participates in the PPO network?
You can check to see if your provider is part of the PPO network by going to Plan Networks from the selection bar. Once you have entered your member information, you can view the networks available to you.

If the provider you are looking for does not appear online, do not assume they do not participate in the network. You should contact the PPO network directly; their number is located on the back of your ID Card. Since physicians are constantly added to the networks, it is possible the provider you are inquiring about has joined the network since the last update.

Will I ever be required to pay at the time of service?
If you use a physician who participates in the PPO network, they have agreed to submit bills directly to Health Plans, Inc. and collect only the co-payment from you at time of service.

Physicians who do not participate in a PPO used by your plan may request payment at time of service. If this happens, you will need to pay for the services and request an itemized receipt from the provider. You should submit the itemized receipt to the following address for reimbursement:

Health Plans, Inc.
P.O. Box 5199
Westborough, MA 01581

Do I need to select a primary care physician and obtain referrals for specialty care?
No, you are free to select any physician at any time.

Where do I send an overnight mail package?
Overnight mail may be sent to:

Health Plans, Inc.
1500 West Park Drive, Suite 330
Westborough, MA 01581