Get Claim With That Plan First - Sandiego

This guide provides a clear and comprehensive overview of how to fill out the Claim With That Plan First form for emergency medical services. Following these steps will ensure that your claim is completed accurately and submitted in a timely manner.

Follow the steps to successfully complete your claim form.

1. Press the ‘Get Form’ button to obtain the Claim With That Plan First form and open it in your online editor.
2. Read through all sections of the form carefully. Begin by completing the patient information, including the patient's name, address, and date of birth.
3. Fill in the subscriber's details, such as the name and address, ensuring to provide the correct relationship to the patient.
4. Indicate the place and time of the emergency incident, as well as the place of emergency care, accurately noting the dates.
5. Respond to the questions regarding insurance coverage and any other medical coverage the patient may have, including Medicare or automobile insurance, if applicable.
6. Detail the circumstances surrounding the emergency by describing how it occurred and why treatment was not sought at a Kaiser Permanente facility.
7. Complete additional sections, if applicable, regarding ambulance usage, hospitalization, and the authorization for medical records.
8. Carefully review all inputted information, sign the form, and date it in the designated area.
9. Attach all required documentation, including itemized bills and any additional requested information.
10. Save your changes and proceed to download, print, or share the completed form as necessary before mailing it to the correct claims department address.

Start filling out your Claim With That Plan First form online now to ensure your medical expenses are reimbursed promptly.