Tips for completing hospital confinement/outpatient surgery by using the paper form You can file a hospital confinement/outpatient surgery claim if you or a dependent on your policy has undergone outpatient surgery or incurred out-of-pocket expenses related to a hospital stay, such as:
Deductibles, co-payments and co-insurance associated with hospital confinement
If you find yourself in this situation, we're here to help. Use these tips to guide you through the process of filing a hospital confinement/outpatient surgery claim.
Keep in mind that filing claims online and setting up direct deposit are the fastest ways to start receiving benefits. You also may print and complete the forms by hand.
Download the hospital confinement/outpatient surgery claim form.
For the fastest filing, fill out each section of the form on your computer. When you open the file, you'll see gray boxes, which indicate areas where you can type your information.
Review and complete the Optional Service Release Agreement. This section allows you to provide permission for Colonial Life to release information about your claim to individuals you designate, send claim payments by overnight delivery and make direct deposits into your bank account.
Check the boxes that relate to the type of claim you're filing.
Complete Section 1 in its entirety.
If you're filing a claim due to an accident, complete Section 2, including the accident date and description.
Along with your claim, please submit a copy of the itemized bill showing the admission, discharge dates and the daily room charges; a copy of the itemized surgeon's bill showing the diagnostic/procedure codes and a copy of the operative report. If you're unable to provide billing statements, please have your physician complete and sign sections 3 and/or 4, as applicable.
Sign and date your claim form, and complete and sign the authorization page.
Carefully review your forms to ensure all required sections are completed, including all areas where a signature and date are needed.
If you were in an auto accident, gather a copy of the accident report.
Submit your claim forms and documentation online by logging in to your account. If you don't have an account, register here. This is the fastest way to start receiving benefits. You can file your claim, upload documentation for an existing claim, track the status of your claim and view other communication through your online account.
Alternatively, you can fax your claim to 1-800-880-9325 or mail it to P.O. Box 100195, Columbia, SC 29202-3195.
Watch the hospital indemnity claim video walkthrough