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Filing Claims

Prescription drug and dental benefits are administered by Express Scripts and Delta Dental. (You will find the contact information for the Fund's Claims Administrators in the Summary of Benefits section.)

Each professional claim filed with the Fund should include the following information:

  • Participant's Name
  • Patient's Name
  • Patient's Date of Birth
  • Provider's Federal Tax ID Number
  • Procedure Code (provided by doctor on bill)
  • Diagnosis Code (provided by doctor on bill)
  • Participant's Health Fund ID Number (as it appears on the Health Fund ID Card)
  • Provider's Name
  • Provider's Address
  • Amount Paid (if any)

Provider Claim Submission

If you use a network provider, you are not responsible to submit the claim. Your network doctor, hospital or other provider will automatically accept assignment of benefits and submit the claim on your behalf. All you have to do is pay the applicable co-insurance, copayA fixed dollar amount you pay for an eligible expense at the time the service is provided. and deductible, if any.

If you use a non-network provider and the provider does not bill on your behalf, see the "Participant Direct Claim Submission" section that follows. You may designate an authorized representative, such as your Business Manager, to submit claims on your behalf. Call the Administrative Office for details about what you need to do to designate a representative.

Provider claim submissions are required to be sent as follows:

California Provider Paper Submission

Anthem Blue Cross
P.O. Box 60007
Los Angeles, CA 90060

California Electronic Submission: Anthem's electronic claim submitter number: 47198

Non-California Provider All Claim Submission

See our website* and click on the "Claim Submission" tab, then on the "Hospital Claim" or "Professional Claim" link to locate the local Blue Cross office in your state.

Participant Direct Claim Submission

If you are filing your own claim, you must submit your claim directly to Anthem Blue Cross or your local Blue Card office, using a participant direct submission claim form. You can obtain a copy from our website at www.wgaplans.org, forms section. It is recommended that you retain copies of the claims you are submitting.

ALL California participant direct claim submissions, with the exception of the claims noted on the next page are required to be sent to Anthem Blue Cross, using a participant direct submission claim form.

Anthem Blue Cross
P.O. Box 60007
Los Angeles, CA 90060


See below for the non-California participant direct claim submission.


Important!
Foreign Claims

If you receive medical treatment in a foreign country, you should first contact BlueCard World Service Center for access to medical assistance services and healthcare providers around the world. (On the backside of your Medical ID Card, the phone number is listed under the title "To Find a Blue Card Provider".)

For inpatient care at a BlueCard Worldwide® hospital that was arranged through BlueCard Worldwide Service Center, you only pay the provider the usual out-of-pocket expenses (non-covered services, deductibleThe amount you must pay for covered services in a plan year before the plan begins to pay benefits., co-paymentA fixed dollar amount you pay for an eligible expense at the time the service is provided. and co-insuranceThe percentage of eligible expenses you're responsible for paying.) when cashless access is arranged. The provider files the claim for you.

For all outpatient and professional medical care (including inpatient services where cashless access in not arranged), you must pay the provider fees at the time of service. then submit a claim, in English, with invoices, any applicable medical records, and a statement with U.S. currency and currency exchange rate at the time of payment, to the administrative office for consideration of benefits.

Claims can be submitted directly to the Worldwide Service Center who will convert and translate your claims in preparation for processing by the Administrative Office. See our website at www.wgaplans.org, forms section for a copy of the International Claim Form.


ALL non-California participant direct claim submissions, with the exception of the claims noted below, are required to be sent to your local Blue Card office using a participant direct submission claim form. Refer to our website at www.wgaplans.org to locate the address of your local Blue Card office.

To receive Plan benefits for non-network claims, you must submit your non-network claims to your local Blue Cross/Blue Card office within the two-year filing limit from the date you incurred the service. Any claims received later than two years after that date will be denied.

The claims noted below from California and non-California providers can be submitted directly to the Administrative Office at the following address:

Producer-Writers Guild of America Pension Plan
Writers’ Guild-Industry Health Fund
2900 W. Alameda Ave.
Suite 1100
Burbank, CA 91505-4220

  • Routine Vision Claims from Non-Traditional Vision Providers. Some examples of non-traditional vision providers are as follows:
    • Costco;
    • Lenscrafter;
    • JC Penny; or
    • Walmart
  • Wellness Claims from Non-Traditional Healthcare Providers. Some examples of wellness claims from non-traditional healthcare providers are as follows:
    • Receipt for a flu shot received at a drug store;
    • Invoice for a smoking cessation program;
    • Invoice from a weight-loss program; or
    • Lifestyle Classes offered by the Motion Picture & Television Fund (MPTF).
Foreign Claims

While traveling, if you receive medical treatment in a foreign country, you should first contact the BlueCard World Service Center for access to medical assistance services and healthcare providers around the world. (The phone number is listed under the title "BlueCard Worldwide" on the backside of your Medical ID Card). For in-patient care at a BlueCard Worldwide hospital arranged through the BlueCard Worldwide Service Center, you only pay the provider the usual out-of-pocket expenses (i.e., non-covered services, deductible and copayment expenses). The provider files the claim for you. Otherwise, if you receive medical treatment in a foreign country, you must pay the provider fees at the time of service, and then submit a claim in English with invoices, any applicable medical records, and a statement which includes the U.S. currency and currency exchange rate at the time of payment.

For outpatient facility and physician services or inpatient care not arranged through the BlueCard Worldwide Service Center, you will need to pay the healthcare provider directly and submit a BlueCard Worldwide International claim form with original bills, your participant Health Fund ID Number (as it appears on the Health Fund ID Card) and receipts to the BlueCard Worldwide Service Center.

If you live in a foreign country, your claims can be submitted directly to the BlueCard Worldwide Service Center for processing. They will handle the front-end processing of your claim by converting the foreign currency and providing any necessary billing translation. The claim will be electronically transmitted to the Fund for benefits determination.

BlueCard Worldwide International claim forms are available on our website, www.wgaplans.org, under"Forms" or visit www.BCBS.com/bluecardworldwide. It is recommended that you always retain copies of the claim(s) you are submitting.

BlueCard Worldwide Service Center: P.O. Box 261630 Miami, FL 33126 USA or call 1-800-810-2583 or collect: 1-804-673-1177.

Assignment Of Benefits

"Assignment of benefits" means that you're authorizing the Fund to pay the provider directly rather than paying you. Benefits are assigned automatically to network providers based on their agreement with the PPO network. Benefits may also be assigned to a non-network provider if he/she allows it.

Notwithstanding the foregoing, no benefit payable under the terms of this Health Plan shall otherwise be subject to the debts, contracts or liabilities of any individual covered by this Fund.

Timely Filing Rules

In-network claims (Facility and Professional claims) are subject to Blue Cross/BlueCard's network timely filing limitations. Out-of-network claims (Facility and Professional claims) not filed within two years of the date of service will be denied.

If your medical claim is the result of injuries suffered in an accident, you must submit details concerning the accident with the accident-related claim. (See the Fund's Right of Reimbursement and Subrogation section starting on page 118 of the Summary Plan Description.)

Claim Determinations

The Claims Administrator may deny or grant a claim, in whole or in part, at his/her discretion. The Fund's claims provisions will be applied consistently for claimants in similar circumstances who are similarly situated, as determined by the Claims Administrator. (See Administrative Information, of the Summary Plan Description for more information about your rights under the claims and appeal process. Network providers are subject to Blue Cross/BlueCard timely filing limitations.)