Quick answer
Usually you don’t have to. In-network doctors, hospitals and pharmacies file claims for you. You file your own when a provider doesn’t bill your plan, such as an out-of-network doctor, a therapist who gives you a superbill, or a clinic abroad. To file, get an itemized bill, fill out your insurer’s claim form (often online), attach the bill and proof of payment, send it before your plan’s deadline and keep copies.
Key takeaways
- In-network providers file for you. Show your insurance card at every visit.
- You’ll usually file yourself for out-of-network care, care abroad, or when a provider won’t bill your plan.
- You’ll need an itemized bill with service and diagnosis codes, plus your member ID.
- Plans set filing deadlines. Original Medicare’s is 12 months from the date of service.
- If a claim is denied, you have at least 180 days to appeal a job-based plan’s decision.
On this page
When you need to file a claim yourself
- Out-of-network care from a provider that doesn’t bill your plan. See what to do about out-of-network costs.
- Therapists and other providers who have you pay upfront and give you a superbill.
- Care outside the U.S.
- Prescriptions you paid for at a pharmacy that didn’t run your insurance. See does health insurance cover prescription drugs.
- A second plan. If you have two health plans and the provider only bills the primary one, you may need to send the claim to the secondary plan.
- Emergencies where the hospital never got your insurance information, like an ER visit away from home.
If your doctor is in network, the office should file for you.
What you’ll need
- Your member ID and group number, from your insurance card.
- The patient’s name and date of birth.
- An itemized bill showing each service, the date, the provider’s name and tax ID, and the procedure and diagnosis codes.
- Proof of payment, if you already paid.
- Details about any other coverage, or about an accident or work injury, since auto insurance or workers’ comp may need to pay first.
ACA plans can’t deny a claim because a condition started before your coverage did. See getting health insurance with pre-existing conditions.
How to file, step by step
- Get an itemized bill or superbill from the provider, and check it against the care you received.
- Get your insurer’s claim form. Most insurers let you file in their app or on their website. You can also call the member services number on your card.
- Fill it out completely. Missing codes or signatures are a common cause of delays.
- Attach the itemized bill and receipts. For care abroad, include a translation if your insurer asks.
- Submit it and keep copies. Note the date you sent it, and use tracking if you mail it.
- Watch for your explanation of benefits. It shows what the plan paid and what you owe. See what an explanation of benefits is.
- Follow up if you don’t hear back. Job-based plans generally must decide a claim for care you’ve already had within 30 days, though they can take an extension in some cases.
Filing deadlines
| Coverage | Deadline |
|---|---|
| Original Medicare | 12 months from the date of service. Use form CMS-1490S if your provider won’t file |
| Job-based and individual plans | Set by the plan. Check your plan documents or call member services |
| Medicare Advantage and Part D plans | Set by the plan |
If your claim is denied
Read the reason on your explanation of benefits or denial letter. Simple problems, like a missing code, can often be fixed by resubmitting. For other denials, file an internal appeal. Job-based plans must give you at least 180 days to appeal. If the plan upholds its decision, you can usually ask for an independent external review. See how to appeal a health insurance claim denial.
A denied claim is frustrating, but going without coverage is far riskier; see the worst that can happen if you get sick without health insurance. If your insurer makes claims a constant hassle, compare the best health insurance companies at your next open enrollment.
Looking for a plan with doctors who bill your insurance directly? Compare quotes by ZIP code.
Frequently asked questions
Do I need to file a claim if my doctor is in network?
No. In-network providers file claims for you.
How long does an insurer have to decide a claim?
Job-based plans generally have 30 days for care you’ve already received, 15 days for approval before care and 72 hours for urgent care. Many states set prompt-pay rules for the insurers they regulate.
Can I file a claim for care I got in another country?
Often, if your plan covers care abroad. Many U.S. plans cover only emergencies outside the country, and Original Medicare generally doesn’t cover care outside the U.S.
What’s a superbill?
An itemized receipt with the codes your insurer needs. Providers who don’t bill insurance, like many therapists, give you one so you can file for reimbursement.
Sources
This article is general information, not insurance advice. Claim rules and deadlines vary by plan, so check your plan documents. Last reviewed September 2026.