Prescription Drug Claim Forms
Use this form if you've paid for a prescription you'd like SCAN to reimburse you for.
Forms
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
Forms
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.