If you have Blue Cross Blue Shield OR Cigna cover then click on the icon to download a .pdf file of the overseas claim form (you will need the Adobe software to do this).

 

All you have to do is print it out, fill it in and post with all the relevant medical receipts from the physician, pharmacist or lab to the address on the form.

A generic claims form suitable for most insurance companies can be download from this US governmental site:

 

 

For this the doctor must have received, before the consultation, a guarantee of payment directly (usually faxed to the office +39 055 288055) from the health insurance organisation stating that the patient is covered for medical care abroad and what the co-payment / deductible is.

First of all the patient must request the consultation with the insurance company / health care organisation.

If the following form is completed (enter as much info. as possible) and printed out along with the example request letter it can then be faxed to your health care organisation.

Insurance identification number

Patient's name Patient's date of birth (mm/dd/yy)

Name of subscriber Subscriber's date of birth (mm/dd/yy)

Subscriber's current mailing address

Patient's sex, male female Patient's relationship to subscriber

Patient's contact phone numbers i) home ii) work iii) cell

I have the following symptoms / medical problem I require an office consultation with the following physician:

Dr Stephen Kerr

address:

via Porta Rossa 1,

Firenze, 50123, Italy

Tel / Fax +39 055 288055

 

I request the fees for the office consult to be paid directly to the provider's office with clear details of any deductibles or co-payment that would be applicable for a routine office consultation. If the co-pay is nil (i.e. I have 100% cover) please indicate "this patient does not need to pay a co-payment or deductible. 100% of the fee will be paid to the provider").

 

Signature .......................................................................Date............................................

 

Health care organisation

Tel number

Fax number

E-mail

Blue Cross Blue Shield

+1 804 673 1678

+1 804 673 3575

 

Cigna International

 

+1 800 441 2668

+1 302 797 3100

 

+1 800 243 6998

+1 302 797 3150

cieb@cigna.com

this 'list' is under construction