Hospital Intensive Care (ICU) Claim Filing Instructions
Does your claim meet the definition for Hospital Intensive Care (ICU)?
Definition of Hospital Intensive Care (ICU):
Those special intensive care areas of a hospital which at the time of your admission to the hospital are also
separate and apart from the surgical recovery room and from the rooms, beds, and wards customarily used for
patient confinement.
The term "intensive care unit" does NOT include lesser treatment units such as:
- Progressive or intermediate care units,
- Private monitored rooms,
- Isolation units, observation or
- Telemetry units
These units are classified on the UB-04 in the ‘Revenue Code ‘column and are not covered. Revenue
Codes for lesser treatment units include but are not limited to the following: 0204, 0205, 0206, 0209, and
0214.
Please click on the sample to see where these codes are located on the UB-04 form: UB04 Sample - Revenue
Codes
Submitting a Hospital Intensive Care Claim on Policies Less than 2 Years Old
Complete the Claimant Statement, HIPAA Release, and Medical Provider History. Printable claim forms can be found
below:
Please also include a copy of the CMS 1500 or UB-04 form (only associated with hospital stays) and any itemized
medical bills you would like to have considered for payment. Examples can be found below:
If disability is being claimed, in addition to the documentation above, please have your employer fill out Part A
and your physician fill out Part B on the Disability Claim Form. A printable form can be found here - Disability Claim
Form.
Please mail the completed documentation to the following address:
Globe Life Liberty National Division
Attn: Policy Benefits
P.O. Box 8080
McKinney, TX 75070
Please note: We will examine each covered person(s) for our consideration of each person(s) pending claim.
This will be done at the company's expense. If at any time during the review of your claim we find that we
need additional information, we will notify you in writing.
Submitting a Hospital Intensive Care Claim on Policies More than 2 Years Old
Complete the Claimant Statement. Printable Claimant Statement can be found here - Claimant
Statement
Please also include a copy of the CMS 1500 or UB-04 form (only associated with hospital stays) and any itemized
medical bills you would like to have considered for payment. Examples can be found below:
If disability is being claimed, in addition to the documentation above, please have your employer fill out Part A
and your physician fill out Part B on the Disability Claim Form. A printable form can be found here - Disability Claim
Form.
Please mail the completed documentation to the following address:
Globe Life Liberty National Division
Attn: Policy Benefits
P.O. Box 8080
McKinney, TX 75070
Claim Benefit Payment Options
You can receive your payment via direct deposit or by conventional mail. To sign up for direct deposit:
- Click on the Customer Login link in the menu bar
- Once you are logged in, select Policy Changes
- Select Sign up for Direct Deposit
- Enter your banking details
Each of your claim’s payments up to $50,000 will now be direct deposited into your bank account. Your Explanation
of
Benefits can be viewed electronically on the claim’s status page.
Note: If the sum of claim payments in any one day is greater than $50,000, you will receive the
funds paid by check.
Disability claim payments are excluded from ACH and will continue to be paid by check.
If you have questions or need assistance with filing your claim, please contact our Customer Service Department at: