Claim Submission
Covered students are responsible for initiating all medical plan claim forms
for the payment of medical bills.. These forms are available at the University
Health Service office, or on the University Health Service website.
You also may contact Wells Fargo Third Party Administrators, P.O. Box 3262, Charleston, WV 25332-
3262.
When at home or traveling away from
Cleveland, claims must be filed within 90 days of date of treatment. In all cases, expenses must be filed
within 15 months of treatment to be considered for payment under this Plan. In general, the Medical Plan
will reimburse the covered student for all receipted bills and will pay other bills directly to the provider.
Any covered student is encouraged to contact Wells Fargo Third Party Administrators directly whenever
additional assistance or information would be helpful. (The toll-free number is 800-624-8605).
Appeal Process / Denial of Benefits
If the participant believes a claim was improperly settled, please complete the following process:
- Within 60 days of receipt of the claim, the participant may request, in writing, that the plan conduct
a review of the processed claim. The plan will review the processed claim and inform the participant
whether or not an error was made.
- If the participant is not satisfied with the above review, a written request for a second review may be
submitted to the plan within 60 days of the first review. The request should state, in clear and concise
terms the reason for disagreement with the way the claim was processed. When the written request
is received, the claim will be reviewed again and the results of this review furnished in writing to the
participant within 60 days in most cases, but no longer than 120 days.
All requests for review of denied benefits should include a copy of the initial denial letter and any other
pertinent information. Send all information to:
Wells Fargo Third Party Administrators
P.O. Box 3262
Charleston, WV 25332-3262