Filing a health insurance claim means you're requesting reimbursem*nt or direct payment for medical services that you've already received. The way to obtain benefits or payment is by submitting a claim via a specific form or request. There are two ways to submit your health insurance claim.
Key Takeaways
- The easiest way to submit a claim is to have your health services provider do it for you, but they can't do so if they're not in the network.
- You may want to coordinate your benefits and submit two claims, one to your own insurance company and one to your spouse's insurer, if you're covered on two plans.
- You must submit itemized receipts for the health care you received.
- You may be able to file your claim online, which can speed up payment.
What Are the Options To File a Health Insurance Claim?
The first way to file a health insurance claim (and the most convenient) is when your medical services provider can submit the claim directly to the insurance company on your behalf. They can do this electronically through the network.
Your other option is to complete the claim form yourself and send the paperwork to the insurance company yourself. This can be necessary if your health service provider is not in the network for your health plan or can't file it on your behalf.
Note
You may have coverage under one health insurance plan and under your spouse's plan as well. You may be able to get more compensation by coordinating these benefits, using the two plans and filing two claims.
Online Health Insurance Claims: When You Need To Request a Reimbursem*nt
It used to be that you had to submit health insurance claims through the mail, but many companies andmedical benefit plansoffer a few different options. They can depend on the health insurance company.
When you go to the doctor or other medical provider and are told that you have to submit your insurance claim form, it means that the doctor or facility doesn't ask thehealth insurance companyto pay for your bill, and you must do it yourself.
What Kinds of Information Do You Need To File a Health Insurance Claim Form?
You'll have to take certain steps to submit your insurance claim form. First, you must understand your medical bill. You'll also need some basic information to fill out the form.
List of Things on a Health Insurance Claim Form
The claim form should be fairly self-explanatory to fill out. It will ask things like:
- Your insurance policy number, group plan number, or member number
- Who received the services (for example if it was the primary insured or a dependent like a child, spouse, ordomestic partner)
- If there is coinsurance ordual coverage
- What was the visit for (accident,worker's compensation), etc.
Four Steps to Filing Your Health Insurance Claim Form
Obtain Itemized Receipts
Ask your doctor for an itemized bill that lists every service that was provided and gives the cost of each of these services. Make sure any medications or drugs that are provided during treatment are listed with itemized costs. Your health insurance company will require that you attach the original itemized bills to the claim form.
Get Your Claim Form
Contact your insurance company to obtain a health insurance claim form or download a copy from their website. The form will also give you additional instructions about what other information the company might need from your doctor or health care facility.
Note
It's best to read through the form before beginning so you can gather any and all information necessary.
Make Copies of Everything
Don't forget to make copies of everything after you have your claim form filled out and your itemized bills from your doctor. This will eliminate any errors that may be made in the claim process and make it easier for you to refile your health insurance claim if it gets lost.
You might also want to check the billing codes for medical errors and contact your health provider if you need clarification. This step will avoid having your health insurance denied for incorrect information.
Review and Send
Call your health insurance company and tell them you are about to send in your health insurance claim form. Review all the paperwork you have with them and ask if there's anything else you need. Ask how long you should expect to wait for your claim to be paid and mark that date on your calendar.
Send the claim form to yourinsurance company when you're sure everything is in order. The address should be on the claim form.
Note
Keep an eye out on your calendar for the claim date that you marked and contact your insurance company if you don't receive your claim within the timeframe given to you.
Submit Your Health Insurance Claim Form
Check your health insurance company's website before you start filling in the paperwork and heading to the post office,
Submitting Your Claim Online
Many insurance companies offer the possibility to log onto your health and medical benefits plan online. You can ask your employer if your health plan offers this option or contact your health plan insurer directly if your plan isn't through an employer.
Note
There will usually be a place where you can log on if you go to your insurance company's website. Call them and have them help you set it up if necessary.
You may also be able to fill in the information online and submit at least part of the claim via your health insurance company website. You might be able to start the claim and just mail in the supplementary documents with the associated reference number if they don't offer full online submission.
Advantages of Making Your Claim Through a Website
The benefit of submitting claims online is that the payment for your claim may be significantly faster, as soon as 24 hours in some cases.Getting your payment processed as fast as possible is worth going through the effort of setting up an account to manage your services online.
There's also a good chance that you'll immediately see what portion of your claim is covered,what your coinsurance clause is, and what deductible applies. Setting up an account to access your health insurance benefits and claims online will help you be better prepared tounderstand the related health insurance out-of-pocket expenses, and what kind of refund or payment your benefits plan will pay.
When You Have To Submit Your Claim by Mail
Ahealth insurance providermay not offer online submission or may limit online forms to specific services. You may have to print a claim form in this case, fill in all the details, and submit it via the mail.
Frequently Asked Questions (FAQs)
How long does it take for a health insurance claim to be processed?
The time it takes to process a claim can vary depending on the company, but it should take two to four weeks on average. Some states have laws that require them to be processed in 30 or 45 days.
What should I do if a health insurance claim is denied?
Your insurance company will have an appeals process you can use to request that it revisit your claim. It might have been denied in error, or more information may be needed.
Is health insurance claim reimbursem*nt taxable?
Health insurance claim reimbursem*nt isn't taxable in most cases. It doesn't have to be claimed on your tax return. But you should always check with your tax advisor about your personal situation because some health care costs are tax deductible.
