LDP Consulting

Customer Service

FAQ - Frequently Asked Questions

The following Frequently Asked Questions have been provided to help answer some of the more common and general questions that you may have about your health benefits.

LDP's Claims Assistance DirectTM provides personal answers to your specific claims/coverage questions for example, Does my plan cover physical therapy to rehabilitate my son's broken arm? What's the status of the claim I recently filed?

You'll sometimes find the answer you're looking for by clicking the LDP Glossary, which contains definitions/explanations of terms used in the health benefits industry. In fact, it is always good to look in the LDP Glossary first.

Frequently Asked Questions

Q. How do I find out if my doctor is participating with my health insurance plan?

A. Here are four ways to find out:
  1. Call your doctor/health care provider and ask if they participate in your plan.
  2. Look in a Participating Provider Directory. These can be large and sometimes out-of-date. But they list the all the names of health care providers who participate in a given plan.
  3. Check an on-line provider directory. These are usually more up-to-date than printed directories. To find the one for your insurer, go to your insurer's web site. We provide a one-click link to most of the insurance companies which provide plans to our clients.
  4. Call your insurance company's toll-free Customer Service number. To find the number, click on our link to your insurance company's web site.

Q. What if I lose my ID card? How do I get another one quickly?

A. Call your insurance company directly. Tell them your card is lost and request a duplicate. If you're already at the doctor's office without an ID Card, just ask them to call your insurer's Customer Service number to verify that you are covered.

Q. What if I go to a doctor before I receive my ID card?

A. Take your enrollment form as proof of insurance. If you forget to take that, ask him to call the insurer to verify your coverage. In this case, your doctor may ask you to pay at the desk when you leave. For reimbursement, get a claims form from your Human Resources Department and submit it.

Q. What if some of the information on my card is wrong or my name is misspelled?

A. If any information on your ID Card is wrong, call your insurer's Customer Service number. Tell them what's wrong, and request a corrected card.

Q. How do I file a claim?

A. Most claims are filed automatically. Just show your ID card to the provider. They will note the information on your card and send a bill directly to your insurer. Later, in the mail, you'll receive an "information only" statement detailing the amounts, payments, etc. (This is NOT a bill.) If, however, you receive health services from a provider who does not participate in your plan, you will, in that case, need to file the claim yourself. Ask your Human Resource Department to give you the form.

Q. Does it take a long time to process claims?

A. Usually not more than 30 days from their receipt.

Q. If my claim is denied, do I have the right of appeal?

A. Yes. Call the Customer Service number on your ID Card or contact LDP ClaimsDirect and we'll help you with the process.

Q. I've sprained my knee and want a specialist to look at it. Can I just call one?

A. It depends. Some insurance plans allow you to just visit an orthopedist (specialist). Other plans, however, may require you to get a "referral" from your Primary Care Physician. You'll take that with you when you visit the orthopedist. If you don't have a referral, you'll have to pay for the specialist out of your own pocket. Additionally, some plans require a "certification" for certain services. For more information, call your insurance company's customer service number or contact LDP directly.

Q. Do I have to be ill or injured to see a doctor or can I go in for regular checkups?

A. Most plans cover routine visits to your doctor under "preventive care services." This means, for a few examples, routine gynecological examinations (without a referral), cholesterol screening, mammograms, electrocardiograms, maternity care, well-child care, and regular physical examinations.