Claims Submissions

Claims Process

These procedures apply to claims submitted both in and out-of-network. Individuals can search for doctors and hospitals in our network by using our provider search. You are welcome to contact our global customer support by phone, or visit our website to obtain additional information or to ask questions about your insurance.

Claims Appeals

While Tokio Marine HCC - MIS Group takes every effort to provide the accurate benefit to each claim, there may be situations when the member chooses to appeal how a claim was processed. In order to do so, the member may submit a written letter of appeal with additional documentation (medical records, receipts, etc.) to support their reasoning and position.

The letter should be sent to:

Tokio Marine HCC - Medical Insurance Services Group
P.O. Box 2005
Farmington Hills, MI 48333-2005

An appeal request can also be completed online here or by sending an email with the appropriate information and files attached to [email protected].

Please note that submission of the appeal will lead to re-evaluation of the claim but does not guarantee that the initial benefit determination will be altered. Please see the certificate wording or contact us to determine if additional or alternate procedures apply.

Claims Submission

A completed claimant’s statement and authorization is required for every claim episode and is available for download on our website. We will also be happy to fax, e-mail, or mail a claimant’s statement to the member. If providers are willing to accept payment directly from us, the member must sign the “Authorization” section in Part C of the claimant’s statement. Alternatively, we will honor assignments from the provider.

Providers or applicants can mail itemized bills, including diagnosis, to:

Tokio Marine HCC - Medical Insurance Services Group
Box No. 2005
Farmington Hills, MI
48333-2005

A claim can also be submitted online here or by sending an email with the appropriate information and files attached to [email protected].

While we are always willing to settle the claim directly with the healthcare provider, we can never guarantee that the provider will accept proof of insurance as sufficient and accept assignment of benefits.

We are not able to pay a provider in advance of services rendered. We must have the ability to adjudicate the claim properly and while we will verify benefits at any given time, it is never a guarantee of payment. Working with the provider, we negotiate fees for services depending on in-network and out-of-network charges. We encourage providers to settle the claim directly with us rather than requiring immediate payment from the member.

In the case that a provider is unwilling to settle the claim directly with us, the member will simply need to complete a claimant’s statement and authorization, attach the original itemized bills and paid receipts (if applicable), and mail it to us.

We encourage members to make copies of all of the documentation (claim forms, bills, and receipts) that they send to us to retain for their own records. If additional information is requested, further processing time may be necessary depending upon the response time of the parties from whom the additional information was requested. Charges for medical records requested as part of the claims process are borne by Tokio Marine HCC - MIS Group.

It is common for the claims department to request copies of medical records relative to a claim or a part of the patient’s medical history. Consequently, we encourage individuals seeking treatment outside of the U.S. to obtain the medical records at time of treatment and submit them along with the other documentation for the claim.

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