Frequently Asked Questions

Claims

How do I file a medical claim?
How do I file a dental or orthodontia claim?
How do I file a vision claim?
How do I file a claim involving Coordination of Benefits (COB)?
How do I file a claim for weekly income benefits?
How do I file a claim for mental health services?




QUESTION: How do I file a medical claim?

ANSWER:

Before any claims can be paid for a dependent spouse, a certified copy of your marriage certificate must be on file at the Fund Office.

All medical claims (with the exception of prescription drugs) will be filed by your medical provider directly with their local Blue Cross/Blue Shield office. Claims will then be transmitted to Lineco by Blue Cross/Blue Shield for processing. You do not need to file any bills or claims forms directly with the Lineco office.

Retail prescription drug claims (non-Medicare eligible individuals) should be filed directly with the Lineco Fund office. Medicare eligible individuals should not mail their RX claims to Lineco because their 80% benefit is already received at the time the RX is purchased.

If Medicare is primary for a medical bill, then you or your provider should send a copy of the bill and the Medicare Explanation of Benefits to the Fund office.

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QUESTION: How do I file a dental or orthodontia claim?

ANSWER: Before any claims can be paid for a dependent spouse, a certified copy of your marriage certificate must be on file at the Fund Office.

Mail all dental claims to the Fund Office.

Line Construction Benefit Fund
821 Parkview Boulevard
Lombard, IL 60148-3230

800-323-7268 8:30 AM - 4:30 PM (CST) Central Standard Time

NOTE: YOUR DENTIST CAN NOW FILE CLAIMS ELECTRONICALLY
Please tell your dentist that Lineco is now able to receive dental claims that are filed electronically through a clearinghouse called WebMD/Emdeon. Electronic filing can speed up the submission and processing of your claims. Lineco's WebMD/Emdeon payor ID number is LCB01.

When you or a dependent need dental or orthodontic care, your dentist may use his own form. The following rules and procedures apply:

  1. If the dentist's charges will be LESS THAN $1,000, it is not necessary to submit the claim for predetermination of benefits. File your claim as follows:
    • Complete the employee information portion of the dental claim form.
    • Have your dentist complete the dentist's portion of the dental claim form after he has completed his services.
    • The dentist should keep one copy of the dental claim form for his files. You or your dentist must send the completed dental claim form to the Fund Office.
  2. Predetermination of Benefits Procedure - If the dentist's charges will be $1,000 OR MORE, your claim should be submitted for "predetermination of benefits" as explained below before any major work is started.

Predetermination of benefits doesn't apply to orthodontic care.

Before a dentist performs any dental services, have the dentist submit to the Fund Office the details of his proposed treatment plan and charges for the treatment.

This information should be filled in on a dental claim form. The dentist should keep a copy of the claim form and send the rest of the claim form, along with appropriate x-rays, to the Fund Office. The Fund Office will review the proposed treatment plan and charges. The Fund Office will advise you and the dentist of the amount the Plan will pay so you will know how much of the bill you will have to pay. If the dentist is charging more than reasonable and customary fees, then you can try to negotiate a lesser fee from the dentist, pay the extra charge, or change dentists.

If you don't want to follow the predetermination procedure, you can just submit your claim after the dental work is done. However, you may be unpleasantly confronted with a large, unexpected out-of-pocket cost.

When the Predetermination Procedure Is Not Necessary - Your dentist can perform oral examinations, cleanings, fluoride applications, and dental x-rays before submitting the claim for predetermination. In addition, no predetermination is necessary when the charges for a plan of treatment are expected to be less than $1,000 or when emergency treatment is performed.

If emergency dental treatment is performed because of an accident or other dental emergency, it won't be possible to obtain a predetermination before getting treatment. However, if the dentist must render additional non-emergency treatment in connection with the dental emergency, a predetermination of benefits claim form should be submitted by your dentist and reviewed by the Fund Office prior to such work if the charges for the additional dental services will be $500 or more. In addition, the predetermination of benefits form should be accompanied by a bill or other explanation of the emergency treatment that was rendered by the dentist.

A PREDETERMINATION OF BENEFITS DOES NOT GUARANTEE PAYMENT FOR DENTAL BENEFITS. COVERAGE IS VALID ONLY UPON DETERMINATION OF ELIGIBILITY.

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QUESTION: How do I file a vision claim?

ANSWER: If you use a non-Panel doctor (a doctor who does not participate in VSP) for your vision care, follow these steps to get reimbursement:

1. Pay the doctor in full. Get a paid receipt for the itemized bill showing the services performed and supplies provided. The bill must be itemized, especially with regard to showing the type of lenses prescribed, i.e., single vision, bifocal, trifocal or contacts.

2. Be sure the bill includes your name, address and your ID number (if the patient is a dependent, the dependent's name should also be on the bill).

3. Send the itemized paid bill, along with a completed HCFA-1500 or generic claim form, to:

Vision Service Plan
P.O. Box 385018
Birmingham, AL 35238-0518

You will be reimbursed according to the Non-Panel Doctor Reimbursement (See Schedule of Benefits.)

You can contact VSP for more information at the address shown above or at one of the following telephone numbers:

800-877-7195

800-428-4833 (TDD. for the hearing impaired) REMEMBER: DON'T SEND BILLS FOR VISION CARE TO THE FUND OFFICE!

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QUESTION: How do I file a claim involving Coordination of Benefits (COB)?

ANSWER: When Another Plan (Carrier) Is Primary and LINECO is the secondary payer on claims, you must submit BOTH a copy of the fully itemized bill AND the other carrier's Explanation of Benefits form to the Fund Office. Be sure to indicate the name and your ID Number of the LINECO employee or retiree when you send these items to the Fund Office, whether claim is for the employee, retiree or a dependent.

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QUESTION: How do I file a claim for weekly income benefits?

ANSWER: A claim for the $400 (effective with new disabilities 3/1/08 or later) Weekly Income Benefit should be filed as soon as your absence due to the disability exceeds your waiting period (first day accident and hospitalization, 8th day illness). Contact the Fund Office to get claim forms.

After completing your section of the Weekly Income Benefit form, have both your employer and doctor immediately fill in their sections and return the form to the Fund Office.

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QUESTION: How do I file a claim for mental health services?

ANSWER: Claims for mental or nervous disorders and substance abuse should be sent directly to the Lineco fund office. Do not send these claims to Blue Cross). Be sure that all treatment has been certified by ValueOptions--Lineco's Mental Health Certification Company.

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