Coughlin

Step-by-Step Guide to Filing Claims with Coughlin

1. Log In or Register

• New Users:
  • Visit the Coughlin Portal Login and click “Register” (if available) or contact Coughlin’s support for account setup
  • Use your policy number and personal details (provided by your employer or benefits administrator) to create an account.
• Existing Users:
  • Sign in with your username and password.

2. Prepare Required Documentation

• Original Receipts: Ensure receipts include provider name, service date, cost, and patient’s name. Non-itemized receipts (e.g., cash register slips) are not accepted
• Supporting Documents:
  • Medical Claims: Prescriptions, diagnostic reports, or physician referrals (if applicable).
  • Property/Auto Claims: Police reports, repair estimates, or photos of damages
• Claim Form: Download from the portal (if required) or submit directly through the online interface

3. Submit Your Claim

1. Online Submission:
   • Navigate to “Submit a Claim” in the portal.
   • Upload scanned receipts and forms (JPEG/PDF/PNG).
   • Fill in claim details (e.g., service type, date, cost) and confirm accuracy
2. Alternative Methods:
   • Phone: Call Coughlin’s Ottawa office (1-888-613-1234) or Winnipeg office (1-888-204-1234) for guidance
   • Mail: Send documents to Coughlin’s claims department (address provided in your policy documents).

4. Track and Receive Payment

• Processing Time:
  • Electronic claims: Typically resolved within 5–10 business days
  • Manual submissions: Allow 7–14 business days (plus mailing time).
• Payment Methods:
  • Direct deposit (enroll via the portal) or cheque.
• Status Updates: Use the portal’s “Claims History” tab or contact support

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FAQ: Coughlin Claims Process

1. How long does Coughlin take to process claims?

Most electronic claims are processed within 5–10 business days. Complex cases (e.g., disability claims) may take longer

2. What documents are required for paramedical claims?

• Original receipts with provider details (license number, service date).
• Prescriptions or referrals for specialized treatments (e.g., physiotherapy)

3. What if my claim is denied?

Resubmit with corrected documentation or contact Coughlin’s support team at 1-888-613-1234 (Ottawa) or 1-888-204-1234 (Winnipeg)

4. Can providers bill Coughlin directly?

Yes. Confirm if your provider uses Coughlin’s direct billing network. Present your Coughlin Insurance Card at appointments to avoid upfront payments

5. What is the deadline to submit claims?

Claims must be filed within 12 months of the service date unless otherwise specified in your policy

6. How do I update my banking details?

Log in to the portal → Navigate to “Payment Settings” → Enter new account information

7. Are mental health services covered?

Coverage varies by plan. Check your policy’s “Extended Health Benefits” section for psychologist or counsellor limits

8. How do I track my claim status?

Use the portal’s “Claims History” tab or contact Coughlin’s support team

9. What if I encounter login issues?

Reset your password via the portal’s “Trouble Logging In?” link or contact support during business hours

10. Does Coughlin cover travel emergencies?

Check your policy for travel insurance inclusions. Submit emergency receipts post-trip via the portal or email

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Things to Remember

1. Plan Coverage: Know Your Limits

Understanding Your Yearly & Per-Session Coverage
Insurance plans have annual limits (e.g., 500/year) )and per−session reimbursement rates (e.g.,$80-$100/session).

• Why it matters: If our clinic’s fee is $120/session and your insurer covers 80/session, you’ll pay $40 out−of−pocket ($120 - $80).
• What to do:
  1. Contact your insurer to ask:
     • “What’s my annual limit for [service]?”
     • “What’s the approved rate per session?”
  2. Check your policy documents for coverage details.

💡 Tip: Always confirm your remaining coverage before booking!

2. Claims: Avoid Payment Surprises

Direct Billing vs. Reimbursement

• Direct billing: We bill your insurer directly. If approved, you only pay your portion (e.g., 20%).
• Reimbursement: If your insurer needs more time to review, you’ll pay upfront, and they’ll refund you later.
  What to do if your claim is pending:
  • Check your insurer’s portal
  • Ask your insurer: “Is there a delay with my claim? When will it be resolved?”

3. Prescriptions/Referrals: Don’t Get Denied

Some Services Need a Doctor’s Referral
What to do:

1. Call your insurer and ask: “Do I need a referral for [service]?”
2. Bring your referral to your appointment.

🚨 No referral? Your claim could be denied!

4. Check Your Coverage: We Can’t Do It For You

How to Verify Your Insurance
For privacy reasons, we can’t check your coverage. Here’s how to do it yourself:

1. Call your insurer using the number on your benefits card. Ask:
   • “Is [service] covered under my plan?”
   • “What’s my per-visit rate?”
2. Log in to your insurer’s portal

5. Cancellations: Avoid Fees

Please Confirm Coverage Before Booking
Unexpected out-of-pocket costs can be lead to last-minute cancellations. To avoid this:

1. Ask your insurer:
   • “Does my plan cover services at this clinic?”
   • “Will I owe anything beyond what insurance pays?”
2. Review our cancellation policy (e.g., 24-hour notice required).