“Straight, simple and to the point – five easy steps to help you efficiently file a health insurance claim.”
When handing over your insurance ID card is not enough to guarantee direct billing, it’s important to know how to submit a claim to your insurance company. This process can reimburse you for any visits you’ve paid for out-of-pocket and ensure your medical bills are paid as promptly as possible.
Step 1: Collect Your Itemized Receipts
To file a claim you need to first obtain an itemized bill from your doctor or medical provider. This bill will list every service you received along with the cost and a special code the insurance company will need to pay your claim. Getting these receipts is relatively easy – simply call your provider and let them know you are filing an insurance claim. From here they should promptly send your itemized receipts after providing a few pieces of information, such as your full name and date of service.
Step 2: Complete A Claim Form
Tip: You can always attach an additional pages to your claim form in case you need more space to properly address each of the questions.
A claim form is the document that tells your insurance company more details about the accident or illness in question. This will help them determine if the expenses you are claiming for are covered under your insurance plan or not, so the more information on this form the better. Keep in mind that each form should have instructions for completing the form and directions on how and where to send it, but if you have questions simply contact your insurance company.
Typical sections of a claim form:
- Personal information like your name, address and date of birth
- Insurance information such as a policy and group number
- Reason for your visit including background information about your condition
- Provider information including the doctor’s name and address
- Out-of-pocket expenses that you have already paid
Step 3: Make At Least 1 Copy
As a preventative measure, it’s always a good idea to make copies of your entire claim before sending it to your insurance company. Keep an extra copy of the competed claim form as well as your collected receipts in case there is a complication with your claim.
Step 4: Review, Call And Send
Tip: If possible, send your claim by email or fax since the process itself will be quicker and you have the opportunity to keep the original documents.
When you have all of your documents completed and ready to be sent, give your insurance company a call. Let them know you will be sending in a claim form and review the paperwork that you’re about to send. Be sure to ask them if there are any additional documents that may need to be sent and how long until you expect for the claim to be paid.
When you are absolutely certain you have everything in order, you can send out your claim form and accompanying paperwork to your insurance company. If you need an address to which to send it, check your claim form. In most cases you will be expected to mail in your claim, but in some cases you can submit your documents by email or fax.
Step 5: Wait
Now there is nothing to do but wait. Keep an eye on your calendar, bearing in mind the claim date that your insurance company gave you when you called. If you don’t receive payment for your claim within the time frame given to you, contact your insurance company and let them know. When you speak to someone make sure to write down the date, time, and full name (or names) and job titles of the people with whom you speak to create a paper trail, which you may need if further problems arise with your claim.
Tip: Don’t be afraid to follow-up with your insurance company after your claim has been submitted to ensure they have all of the necessary documents and that they are filled out correctly.
If you are curious about what you will receive back from your insurance company after filing a claim, check out our helpful tool Understanding Your Explanation of Benefits (EOB). Otherwise, be aware that your insurance company may request additional documents, such as your medical history records to support your claim, so it’s important to stay on top of the process. As always, be sure to contact your insurance company directly if you have questions about filing a claim, claim status or your EOB.
Wondering what may not be covered by your insurance plan?
Read Exclusions to Watch For
Return to our "Insurance Explained" section for more information and help
