How to File a Health Insurance Claim

Health insurance can be confusing. When talking about your health insurance, the conversation usually involves whether or not you have it, or if your plan has good benefits. But how do you actually file a health insurance claim if you need to? Beginning the process of filing a claim can be daunting, but there are four easy steps to get the job done.

Read: 5 Pros and Cons of Pet Insurance — Is It Worth It?

How to file a health insurance claim

We’ve put together a step-by-step process to guide you through filing your health insurance claim.

Step 1: Obtain an itemized bill from your doctor

Before submitting your claim, you’ll need to request an itemized receipt of the services you’ve received from your doctor. You can do so by calling your medical provider and asking for a list of the services you’ve gotten at their facility.
It’s helpful to be able to provide personal identification information and the date that you were treated. Your medical provider will then send your bill to you, most likely via email or portal, though you can request a physical copy to be mailed to your home. 

Step 2: Fill out a claim form

A claim form is an official way of giving your insurance company details about your reason for needing care. This form is how the insurance company decides whether or not your accident or illness is covered under your plan, so be as specific as possible when filling it out. 

If you’re getting treatment for a continued condition, you will probably need to provide proof of your medical history on the claim form. 

Here are some things you’ll be asked to provide on a typical claim form:

  • Insurance policy information, like your plan or member number 

  • If services were provided to a primary user or a dependent

  • Specifics of the treatment, including the reason

  • Any expenses you’ve paid before the visit

You can get your claim form from your insurance company. If the form isn’t posted on their website, you can contact them via phone or email to get one sent to you. 

Step 3: Make a copy for your records

If you don’t keep a record of your medical bills, now is a good time to start! It’s a positive preventative measure to make a copy of your claim to have on file for future reference. This way you can access the claim with ease if you need to. If you don’t have a copy machine, you can do this at your local FedEx or Kinkos. 

Step 4: Submit the claim to your health insurance provider

Many health insurance providers give the option to submit your claim online. Read online to see whether or not yours accepts submissions online, and send it via mail if not. Your claim form should include the correct mailing address for sending a physical copy. 

It’s a smart idea to notify your provider when you submit either way, which can be done with a simple phone call. If you’re not sure you have all the necessary paperwork, consider calling before sending it to avoid any confusion down the line. 

Step 5: Sit tight

It takes time to process health insurance claims, but your health insurance company should give you an expected time frame in which you’ll get a response. After that time window passes, follow up with them if you haven’t received news of your case. 

Keep a concise record of your interactions with the insurance company if you experience problems, including the names and positions of people who have helped you to ensure the best results.

Denied claims

If your claim is denied, don’t be alarmed. The reason your claim has been denied could be a problem with paperwork rather than with the claim itself. The Affordable Care Act gives you the right to an explanation of why your claim was denied, as well as the right to appeal the decision and have an independent review. 

Here are some common reasons for denied claims:

  • Factual mistakes

  • Blank spaces and missing information

  • Claims made outside of time restrictions

  • Treatment falls outside of a given plan’s coverage

  • Treatment is declared unneeded or invalid

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The Financial Gym Team