Fill and Sign the Hospitalmedical Expense Reimbursement Coverages and Benefits Form

Hospital Audit Program Covered persons are expected to review their eligible hospital bills to determine if they actually received the services for which they were billed. If a covered person finds a charge for a service he or she did not receive, the covered person is to contact the eligible hospital and have the hospital correct the bill. The covered person is then eligible to receive one-half of the cost of the items removed from the bill, to a maximum of ${Insert Amount}. While covered persons are in the hospital, they are to keep track of services and treatment they receive, so that they will be better prepared to audit their bills. To be eligible to receive one-half of any corrected error, the covered person is to: 1. Request an itemized bill from the hospital, if one has not already been received. 2. Review the bill for errors such as: length of stay (admission and discharge dates); units of special care (quantity of hours of service); medication, physical therapy, laboratory work, and X rays; amount of time in intensive care, coronary care, or other special care units; and amounts of supplies and take-home drugs received. 3. If the bill is correct, no action is necessary. The eligible hospital bill will be processed. If it is not correct, contact the hospital's accounting office and have the bill corrected and returned to you. 4. Send the original and corrected bill to the claims administrator as soon as possible. Highlight the errors and note the total. You will receive a check for one-half of the difference between the original and corrected bills, up to a maximum of ${Insert Amount}per hospital stay. The amount of the check you will receive will reduce the amount you may declare as medical expenses when you file your income taxes.