How does the claim/sharing process work?
Members do not file claims because GraceWell is not an insurance company.
If you have had health insurance in the past, some aspects of GraceWell may seem familiar. When visiting the doctor, members present their both their Medicare card and their GraceWell Member ID Card to their service provider. The provider then processes the bill accordingly.
Once a Medicare Summary Notice (MSN) and a provider bill is received by GraceWell, we review the services provided to determine eligibility. After the Personal Responsibility Amount (PRA) has been met and if the bill is eligible, it is submitted for sharing among the other members.
Always review your Explanation of Sharing (EOS) and compare that to the bill from your provider for your portion. If the amounts match, then you will be responsible to pay that portion. If the amounts do not match, please call GraceWell so that we can help.
You may view all of your EOS documents within your Member Center.