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A health insurance claim is the request made to a healthcare provider for medical services coverage. You or a healthcare provider submits a claim to your insurance company to get paid for medical services. A claim is different than copayment because you file a claim after medical services have already been administered.

The Claim Process

The claim process is not difficult. After you receive medical care, the healthcare professional will send the claim to your insurance company for payment. The insurance company will review the claim and determine whether it is eligible for payment and if so, how much. The health insurance industry utilizes a code system. The codes correspond to the diagnosis and treatment that was rendered. The codes must follow HIPPA guidelines. Once the claim goes through an evaluation process, the company will provide you with an explanation of benefits.

You will receive a document that informs you of the costs of the treatment, the portion that was covered by your insurance, and any outstanding portion that you owe. The explanation and statement is generally not a bill, but it provided for your information only. Before you receive medical care, your doctor or healthcare provider will request your insurance information so they can work directly with your insurance company to submit the claim.

How to File a Health Insurance Claim

When you visit your primary care physician who is part of your network, you provide your insurance card and the doctor’s office will handle submitting the claim. All you will need to do is pay the initial co-payment that is due at the time of your visit. When you visit a provider who is not in your network, or when you obtain medical care that isn’t covered by your plan, you might have to complete the claim process yourself.
To make the claim process as easy as possible, obtain a detailed and itemized bill for your medical services from the doctor or hospital. You should make sure that you save the bills from your prescription medications so you can submit those along with the costs of medical services. Usually, your insurance provider has a form that you can obtain to complete and submit with a copy of your itemized bill.

Understanding Claims

It is helpful to understand what is and is not included in your insurance policy so you know what to expect when you file a claim. Keep in mind that your policy has co-payments and deductibles that could reduce the amount of the claim. Only allowable charges will be covered by insurance, and any additional expenses will not be approved in your claim. You will receive a statement from your insurance provider after they evaluate your claim. You may still need to provide a portion of the costs or they might deny some of the costs, depending on the particular insurance plan that you have in place.
Insurance claims can be confusing and it is helpful to learn more about the coverage before you choose a policy. At Fast Health Quotes we are here to help you find the best insurance plan to meet your needs and budget. Contact us online or call Fast Health Quotes at 855-244-9579 for fast, friendly guidance in finding the best insurance plan for you and your family.