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Secondary Medical Insurance

 

Process:

The online medical claim is required to be submitted by the Team Coach or Manager who was present at the time of the accident. No other person(s) are authorized to initiate a claim form. If someone other than the Team Coach or Manager submits the claim, it will be denied.
 

Once the claim has been reviewed, an email will then be sent to the parents with a document for their completion if they choose to proceed with a claim. It is then the parent’s responsibility to submit the completed claim form to the insurance company.

 

**Please note that there is a $500 deductible.
    
Step 1

 

The parent is required to provide the following information to the Team Coach or Manager:

 

  • Injured player’s first and last name
  • Date of injury
  • Injured player’s address
  • Detailed explanation of sustained injury
  • Injured player’s date of birth
  • Club/team name
  • Type of injury (concussion, muscular, etc.)
  • Event type
  • Parent’s first and last name
  • Name of facility/field
  • Parent’s contact information (phone & email)
  • Location of facility/field

 

To complete the Online Medical Claim Form please click on the following link: two.pullenins.com/WAS/WASOverview.asp.

 


Step 2
After the Team Coach or Manager completes the form, a Confirmation of Submission email from Pullen Insurance will be sent to the injured person’s parent. The email address the confirmation will come from is pullenins@pullenins.com, so please check your spam filters if you have not received notice within 1 week.

 

Step 3
Once approved, the parent will receive an email with the claim form as a PDF attachment. The parent(s) will need to send the claim form to the insurer, with the itemized medical provider bills and explanation of benefits (EOB) from the claimant’s primary insurance carrier.

 

Please feel free to contact Keli Bitow at KeliB@washingtonyouthsoccer.org with any questions or concerns you may have regarding the online claims submission process.

 
 
 
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