Common Injury Accident Questions and Answers
Have you been in an accident recently and now you’re receiving mail from us? Below are just a few frequently asked questions and answers to help you understand what to do next.
Q: Why is SoonerCare contacting me?
A: SoonerCare has paid for medical care you received due to a possible accident or injury on the date listed on the form. Examples would include a motor vehicle accident or assault. We are following up to see if there might be another party that should have paid for the services. This also applies if you are seeking money for damages due to malpractice or faulty products.
If you are still unsure as to why you received the questionnaire, contact us at 405-522-6205 or toll free at 800-522-0114, option 7, for Third Party Liability.
Q: Why do I have to complete the form? Why can't I just call with the information?
A: Unfortunately, we cannot take information over the phone.
When you complete the form and mail it back, it is reviewed and forwarded to someone who will complete the investigation. If no further investigation is needed, the form is scanned and filed. In both cases, we need the physical documentation to complete the investigation.
However, if you have questions or need assistance filling out the form, please contact us at 405-522-6205 or toll free at 800-522-0114, option 7, for Third Party Liability.
Q: The form says that if I do not respond in 10 days, I could lose my benefits. I just received it and there is no time to return it in 10 days! Now what do I do?
A: We understand the mail may be delayed and you may not have time to get it mailed back within the 10 days.
Don't worry, still complete the form and return it in the postage-paid envelope as soon as possible. If you have access to a fax machine, you can also fax it to 405-530-3478.
Q. Why are you asking if I have other insurance?
A: SoonerCare is the payer of last resort. Because of this, we need to know whether you are covered by any other insurance. Examples include Medicare supplement, Tricare, cancer policy or any commercial health insurance policy.
Q: I completed section A and told you whether I have other insurance besides my SoonerCare or Medicare coverage. Am I finished?
A: Almost, you still need to tell us the reason you had to visit the doctor. To make it easy, there are several sections and more than likely one of those sections fits your situation. Example: Your child was playing a game at the park, and they got hurt. You would use section F for “public place”. Once you find the section that most applies to what/where the incident happened, complete that section. (There is no need to try to have an answer for each section. If you like, you can write N/A for the sections that do not apply.)
Q: I cannot find the section that applies to me. What do I do now?
A: Don’t worry, simply use page four to tell us what happened if none of the other options fit.
Q: I did not have an accident or injury, my visit with the doctor was because of a medical problem. How do I tell you that?
A: If your services were the result of a medical issue only, you can tell us that on page one. In the center of the page, directly above section A, there is a place for you to tell us about the medical problem. Please write your answer on the blank lines after the statement: “if the above diagnosis is related to an illness only, please explain how the illness relates to the above diagnosis”.
Q: I keep getting these, why are you sending me so many?
A: If you received more than one of our questionnaires for the same accident or medical illness, it is because we have paid more than one claim for you with this or a similar diagnosis. For example, medical services related to a broken bone results in several claims: There may be an ER visit, a claim for your x-ray and a claim from the radiologist (the provider reading and performing the report for your x-ray). It’s not unusual for more than one questionnaire to go out per “incident”, so please keep that in mind. We also ask that you complete each questionnaire since we will not know, until we ask, what the circumstance was for your visit.
Q: I lost one or more of the pages for the questionnaire. Can you send me a replacement?
A: Yes, call us and we can send out a copy of the one you received. You may contact us at 405-522-6205 or toll free at 800-522-0114 option 7 for Third Party Liability.
Q: I completed the section that asked whether I had an injury or if I was seen for a medical reason only. What else do I fill out?
A: You just need to fill out section K (on page 3). On page 3, complete parts 1 and 2, if you had some type of accident. If your visit with the provider was illness related, only complete part 2. Once finished, you are ready to mail all the pages back to us in the postage paid envelope.
Q: I did not have this service or see this provider, how do I let you know?
A: Please contact us at 405-522-6205 or toll free at 800-522-0114 option 7 for Third Party Liability and we will look at this with you.