You enrolled. Here is what comes next.
Start with the insurer’s member services number on your card or policy. Sam can help you organize the question and find the right next step.
https://sjiadvisory.com/resources/client-help/
Before using new coverage
- Confirm acceptance and the effective date. A submitted application is not proof of active coverage.
- Follow the insurer’s first-payment instructions. Check the amount, due date and payment confirmation. An autopay request is not the same as confirmation that payment succeeded.
- Set up the insurer’s member account. Use its official website or the instructions in the enrollment documents. Obtain a digital or physical ID card.
- Recheck planned care. Confirm network participation, referrals and prior authorizations for the active plan.
Choose the issue
I do not have an ID card or cannot confirm active coverage
Call insurer member services using the number in your enrollment documents. Have your application confirmation, effective date and payment receipt available privately. Ask whether enrollment and payment have been processed and how to access a temporary card. Do not assume a provider can verify coverage before the insurer activates it.
I received a bill or a premium notice
For premiums, confirm the coverage period, payment status and due date with the insurer. For a provider bill, compare the service date, provider, billed amount, insurer payment and patient responsibility with the Explanation of Benefits. Ask the provider and insurer to resolve discrepancies before assuming the amount is correct. Do not ignore deadlines while it is being reviewed.
A claim was denied
Get the written reason and appeal instructions. Ask whether the issue involves eligibility, coding, missing information, authorization, network status or an exclusion. Keep a call log and copies of correspondence. Use the plan’s formal appeal process and deadline; a broker conversation is not an appeal submission.
Read the official guide to insurer appeals. Rights and procedures depend on the coverage. For an urgent care-related denial, ask the insurer and treating clinician about expedited review.
A prescription is not covered at the pharmacy
Confirm the active plan and pharmacy, then ask the insurer about formulary status and restrictions. The prescriber may need to submit authorization or an exception request. Do not stop or change medication based on a coverage message without consulting the prescribing clinician.
I want to change or cancel a plan
Confirm the replacement plan’s acceptance, effective date and first payment before ending current coverage. Ask the old insurer how to cancel and request confirmation. Cancellation by itself does not necessarily create a new enrollment opportunity.
Keep a useful call record
Checks and notes stay in this page and are not submitted or saved by SJI. Avoid entering account numbers or medical details. Print for your records.
Ask Sam for help with the next step
Call 813-999-0101 or book a conversation. For a general question, email [email protected]. Do not send Social Security numbers, payment information or medical records by ordinary email.
SJI can help explain the process; the insurer decides claims and confirms benefits. This page is not an emergency or clinical-care service.
Sources and review
Reviewed October 30, 2026. Rules and plan details can change. The insurer, plan administrator or Marketplace confirms your actual eligibility, benefits and dates.