Prescription Drug Claim Forms
Use this form if you've paid for a prescription you'd like SCAN to reimburse you for.
Medical Services Claim Form
Use this form if you paid for healthcare services and want SCAN to reimburse you.
Important information before you ask for reimbursement
If you receive services that are not covered by SCAN or out-of-network services without authorization, you will have to pay the full cost. SCAN does cover emergent or urgently needed care provided out of network. Read our helpful tips for more information.
If you have any questions about a bill or which services are covered, refer to your Evidence of Coverage or contact Member Services at (800) 559-3500 TTY: 711.
Helpful Tips about Billing and Payments
- Always provide your SCAN ID if you get care from a doctor, who is out of your service area.
- If you receive a bill for the full cost of covered services, or if you’ve already paid more than your plan co-payment for covered services and receive a bill, Do Not Pay. Contact Member Services for next steps.
- Contact Member Services before purchasing items recommended by a doctor when using Amazon, Costco, Walmart, CVS, Walgreens, etc.
- If you are admitted to a hospital on an emergency basis, please contact SCAN to notify us of the admission
- SCAN does not reimburse cost-sharing payments (copayment or coinsurance).
Health Services Provided Outside of the United States Claim Form
Use this form if you’ve received a bill from a foreign healthcare provider that needs to be paid.
Important information before you ask for reimbursement
SCAN does not cover routine, pre-planned, or ongoing services outside of the U.S. However, worldwide emergency and urgent care services are offered in some circumstances. Read our helpful tips for more information.
If you have any questions about a bill or which services are covered, please contact Member Services at (800) 559-3500 TTY: 711.
Helpful Tips About Care When Traveling Abroad
Worldwide emergency and urgent care coverage is not covered by Original Medicare and is considered a supplemental benefit. SCAN will reimburse for covered out-of-network emergency and urgent care services outside of the U.S. and its territories at Original Medicare reimbursement rates. You will be responsible for any costs above what Original Medicare would pay, plus any cost-sharing for the services you received. It’s a great idea to purchase a medical travel insurance policy prior to traveling outside of the country.
SCAN offers worldwide emergency and urgent care services outside of the U.S. for emergency services. This includes emergency or urgently needed care, and emergency ambulance transportation from the scene of an emergency to the nearest medical treatment facility (Transportation back to the United States from another country is not covered).
Pre-scheduled, pre-planned treatments (including chronic dialysis) for any ongoing known conditions and/or elective procedures are not covered.
Any follow-up care including after-care, rehabilitation, physician visits, and skilled nursing facility stay are not considered emergent or urgently needed care and are not covered.
