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Claims Process

A claim is information submitted by a provider to establish that medical services were received by a member. Here’s how the claim process works:

1. The health care provider renders a service
2. The provider submits a claim to Unity
3. Unity sends an Explanation of Benefits (EOB) to the member, detailing what Unity has paid.  (You may Sign up to receive your EOB electronically.)
4. The provider will send you a bill if you are responsible for a balance

Unity generally processes claims with 30 days.

How to submit a claim from a non-participating provider
It may be necessary for you to submit a claim if you receive services from a non-participating provider. To do this, you must complete the Member Reimbursement  or Foreign Claim Form. Send Unity an itemized bill, with a receipt to show payment, within 90 days from the date the services were provided. 

Unity recognizes that circumstances beyond your control may not allow you to submit the claim within 90 days. If this is the case, we will process your claim if you submit it within 12 months from the date the services were provided.

If you receive medical care in another country, you must provide an English translation of the claim and include supporting documentation so that we can process the claim. Keep copies of this information and send the originals to us. 

Pharmacy claims
To submit a claim for prescription medication, you must complete a Direct Member Reimbursement Claim Form. Please contact Pharmacy Services for pharmacy claim questions at 800-788-2949.

Claim profiles
If you need a summary of claims processed and paid, call Unity Customer Service and ask for a Claim Profile.  Information on the profile includes dates of service, provider names, total charges, amounts paid by Unity and copayment or deductible amounts.

If you have any questions, or think you may have been billed in error, please contact Unity Customer Service. You may also view your claim information on MyUnity.

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