How Do You File a Health Insurance Claim?

When you come down with a case of the flu, your child falls off his bike and needs stitches, or your spouse develops a stabbing pain in his side and needs to head to the ER, you breathe a sigh of relief because you have health insurance. While health insurance certainly brings the cost of the medical services that you (and your family, if you have dependents listed on your insurance) require down, you need to make sure that your policy covers the expenses. After all, what good is paying your monthly premiums if your medical care isn’t covered?

But, how do you go about making sure that your health insurance does, in fact, cover your medical care? You file a claim. A health insurance claim is a request for reimbursement that is made to your insurance company for medical services that you received. In many cases, your doctor or the facility where the services were rendered will file the claim for you; however, sometimes (depending on your health insurance and who provided your care or where you received it), you may need to file a claim yourself. How do you do that? Read on to find out so that you can make sure you know how to go through the process.

When Would You Have to File a Claim Yourself?

file health insurance claimFirst, let’s discuss when you would have to file a health insurance claim on your own. The easiest way to file a claim is by having your medical care provider or the facility where you received the services submit a claim on your behalf. To do this, the provider would need to file a claim through your network; however, if you see a doctor or receive a service from a medical facility that is not in your health insurance network, a claim cannot be filed for you; in this situation, in order to request a reimbursement for the services rendered, you would need to submit a claim on your own.

Prior to the Internet, the only way to submit a health insurance claim was via the US Post; thankfully, the World Wide Web and other significant technological advances have made the process of filing a claim a lot easier. Now, it’s possible to file a claim online, right through you’re the website of your health insurance company.

Personal Information You’ll Need to File a Claim

In order to file a claim, the first thing you need to do is make sure that you have all of the necessary information. The specific information you’ll be required to supply will depend on your insurance company; however, typically, the following basics will be needed:

  • The policy, group, or member number of your health insurance plan.
  • The name of the individual who received the services.
  • Whether or not you are filing a claim with any other insurance company (for example, if you have two policies, you may be submitting a claim with both).
  • The reason you received medical services; a car accident, an illness, workers’ comp claim, and so forth.

Filing a Health Insurance Claim

Now that you know what type of personal information you’ll need to file a claim, let’s take a look at other information that will be required, as well as how you go about filling the claim itself.

  • Contact your medical care provider. Contact the doctor or facility that provided your medical care and ask for a list of all of the services that you received; it should include an itemized list of the cost of each service. Be sure that everything you were provided with is listed, including bandages, ointments, medications, and other necessities that were used to provide you with the services you needed.
  • Obtain the necessary forms. Next, you’ll need to get a claim form from your health insurance company. Most carriers offer online forms, which you can download and print out yourself; however, if your carrier doesn’t offer online forms or you don’t have access to a computer, you can simply call your health insurance company and request a copy, which they will send to you via the US post.
  • Complete the form. Go over the entirety of the form and make sure that you’ve filled out all of the requested information. You’ll also need to attach the itemized bills you received from your medical care provider.
  • Review, copy, and send. Carefully review your claim to make sure that everything is filled out properly so that it doesn’t get denied. Make copies of the claim so that if anything happens (if it gets lost, for example), you can easily refile it.

The Bottom Line

Submitting a health insurance claim isn’t as complicated as it might seem; however, if you’re unsure, you can speak to your medical care provider – or an insurance agent – whom will be able to provide you with the help that may be required so you can make sure the claim is submitted properly.

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