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1、ClaimFilingInstructions&ClaimFormPleasefollowtheseinstructionspriortofilingaclaimandwhencompletingtheClaimForm.AssistanceisalsoavailablefromtheInternationalMedicalGroup?(IMG?)CustomerServiceDepartmentatthetelephonenumberslistedbelow.IFYOUHAVENOTYETRECEIVEDTREATMENT:Pre-ce
2、rtification(notificationofillnessoraccident):YoumustcallIMGtopre-certifyanyofthefollowingconditions:anytreatmentrequiringhospitalization;outpatientsurgery,CATscans,MRI’s;within48hoursafteranemergencyadmissiontothehospital;careinanextendedcarefacility;homenursingcare;durab
3、lemedicalequipmentincludingartificiallimbs;ortransplants.Pre-certificationmaybedonebyyou,arelative,orahospitalrepresentative.IndependentPreferredProviderOrganization(PPO):YourplanmayrecommendyoureceivetreatmentfromaproviderwithintheUSPPO.Youmayaccessalistingofphysiciansor
4、facilitiesby:·UsingtheIMGwebsite,www.imglobal.com.Thisprovidesacompletelistingofprovidersbyspecialtyandgeographiclocation.·ContacttheIMGCustomerServiceDepartmentatthetelephonenumberormailingaddresslistedbelowforalistofprovidersinyourarea.Pleasenote,duetothesizeofthePPOnet
5、workwecanonlysenddirectoriesforyourimmediatearea.WhenreceivingtreatmentfromaPPOprovider,pleasefollowtheseinstructions:·PresentyourIMGmedicalidentificationcardtotheprovider.·RequestthattheprovidersendthebilldirectlytoIMG.Pleasenote,ifyoupaydirectlytotheproviderforaneligibl
6、eexpensethiswilllikelyaffectyourreimbursementfromIMG.Thenegotiatedfeeforserviceswillbethemaximumreimbursement,whetherpaidtotheproviderortoyou.·CompletetheClaimFormandsubmititwithalloriginalbillsorinvoices.Iftheproviderhasfiledtheclaimsonyourbehalf,simplyforwardthecomplete
7、dClaimFormtoIMG.·WhenreceivingtreatmentfromaPPOproviderforeligibleexpenses,thesubmittedbillsmustbere-pricedthroughthePPOtothenegotiatedrate.Thisproceduremayextendthenormalprocessingtimeofyourclaim.IFYOUHAVEALREADYRECEIVEDTREATMENT:·Ifthisisanewclaim,completeALLPARTSoftheC
8、laimForm.IftreatmentwasreceivedintheUnitedStatesyoudonotneedtocompletePARTC.·Ifthisisacontinuing
