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Claims guide – Treatment expenses
Claims guide – Treatment expenses
Treatment expenses your grant covers
- Office visit charges the day of treatment
- Administrative charges related to treatment
- View a complete list of covered expenses
Not covered:
- Medical services such as lab work, radiation therapy, scans, and surgery.
Paying for treatment expenses
Your grant can cover treatment expenses during:
- Your entire grant eligibility period (12 months from approval date)
- Your look back period (6 months prior to award date)
TotalAssist can pay for treatment expenses by:
- Paying your provider directly
- Reimbursing you for eligible expenses you have already paid
- Payments to you are sent in the form of check by mail, or by EFT if you have signed up for EFT.
Electronic Funds Transfer (EFT)
If you want to have reimbursements directly deposited into your checking account, sign up for Electronic Funds Transfer (EFT) with TotalAssist.
How to submit a claim
Claim form – when submitting a paper form by fax or mail
- Your specific claim form contains a barcode that identifies you in our system. A paper copy is included in your welcome packet in the mail. Please make copies of your barcoded blank claim form so you have some ready to use.
- Remember to sign your claim form before submitting.
Claims in your portal account
- You can complete and submit a claim in your portal account. There is no paper form for this method of submitting a claim.
- Gather required supporting documents for the claim. All documentation must include your name. Handwritten supporting documentation is not accepted.
- View list of required supporting documents
- Submit your claim in your portal account with supporting documentation attached, anytime 24/7.
– or – - Submit your claim by fax or mail. Your claim should include your completed and signed barcoded, patient-specific claim form, plus copies of your supporting documentation. Submit to:
- Fax to: 757-952-0119
- Mail to: TotalAssist, 421 Butler Farm Rd, Hampton, VA 23666
Required supporting documents
To submit a treatment claim, please provide the following
- Your name
- Provider name
- Remit address, if we are paying your provider directly
- Date of service (DOS)
- Procedure costs
- Amount paid by insurance
- Your financial responsibility
- Your name
- Insurance name and logo
- Date of service (DOS)
- Procedure codes
- Amount paid by insurance
- Your financial responsibility
- Receipts
- Bank or credit card statements
- Cancelled checks
- Itemized statements showing payments made to you
Please make sure all required documents, and your signed, completed claim form, are submitted with your claim. Your claim could be delayed or denied if required documents are missing, if your signature is missing, or if you did not use your patient-specific claim form.
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