A: A PHI Authorization form (PHI form is available under e-forms on the website)

A: Varies depending upon the State which you reside in. For the state of California, Nevada and Hawaii the

age is for anyone under 18.

A: There can be several reasons why the Plan payment is less than the total amount billed:

• · Did you use a preferred provider? If not, you will have a larger portion of the bill to pay out-of-pocket.
• · Have you met your annual deductible? If not, part or all of the bill may have been applied to meeting that annual amount.
• · Does your Plan have limitations of the services you received
  
• (for example, a limit on the number of chiropractic visits within a specified time period or an allowance for tooth cleaning
  only every six months)?
• · Did your procedure require prior authorization which you failed to obtain?
• · The Plan has a specified schedule of covered procedures and benefits.

A: Call the Administrative office for answers, but if you still disagree, you have the right of appeal.

See the Claims Appeal Rights section for more details.

A: This will only be allowed if it is an emergency. A supervisor will need to approve document to be faxed

and followed up with the hard copy in the mail. Please note that the faxed document will only be temporary

for 10 days.