Submission of Claims

An In-Network provider is a provider who has contracted with PBH and agreed to provide services for a negotiated and reduced rate.

When you use an In-Network provider, there are no claim forms required. All In-Network claims are forwarded directly to PBH by the In-Network provider.

Report claims promptly when any individual has incurred covered expenses. This Program only covers claims that are filed within 12 months from the date the services were provided.

After the claim has been adjudicated, you will receive an Explanation of Benefits (EOB) form from PBH. This form will show the total cost of all services, what has been paid to the In-Network provider, and what portion of the claim is your responsibility.

Non-Network Providers

Non-Network providers have not contracted with PBH and have not agreed to provide services at a negotiated rate. As previously stated, there are no benefits for In-Patient/Alternate Care services received from a Non-Network provider.

For Mental Health Outpatient services from a Non-Network provider, you will be responsible for paying the entire cost of the bill. To receive reimbursement under the Program, you will need to submit copies of your bills directly to PacifiCare Behavioral Health.  PBH will determine the amount payable by this Program, if any. The claim will be adjudicated by PBH. You will then receive an Explanation of Benefits (EOB) form from PBH indicating if benefits are payable. If they are, a check will accompany the EOB form.

Report claims promptly when any individual has incurred covered expenses. This Program only covers claims which are filed within 12 months from the date the services were provided.

Submit copies of your bills to PBH. You need to include the social security number of the active eligible electrician, and the social security number of the eligible dependent if appropriate. Indicate that you are covered for benefits under the Southern California IBEW-NECA Local 11 Health Plan.