A health insurance claim is when you request reimbursement or direct payment for medical services that you have already obtained. 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.
What Are the Options to File a Health Insurance Claim?
The first way—and the most convenient—is when your medical services provider can submit the claim directly to the insurance company. They do this through the network, electronically.
The other way is by completing the claim form and sending the paperwork to the insurance company yourself. This situation can happen if your health service provider is not in the network for your health plan or can't file it on your behalf. Then you will have to file the claim to request payment for the medical services you obtained.
If You Have Coverage Under Two Plans: Coordination of Benefits
Sometimes you may have coverage under one health insurance plan and also under your spouse's plan. If this is the case, you may be able to get more compensation by using the two plans and filing two claims. Learn more about the coordination of benefits and multiple health insurance policies.
Online Health Insurance Claims: When You Need to Request a Reimbursement
You used to have to submit health insurance claims through the mail, but with advances in technology, many companies, and medical benefit plans now offer a few different options, depending 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 does not ask the health insurance company to pay for your bill, and you must do it yourself.
What Kinds of Information Do You Need to File a Health Insurance Claim Form?
If you have to file a claim, here are the steps you will need to take along with some helpful tips on submitting your insurance claim form. To complete the steps, you will need to understand your medical bill. You will also need to have some basic information to fill the form out.
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 or domestic partner)
- If there is coinsurance or dual coverage
- What was the visit for (accident, worker's compensation), etc.?
Four Steps to Filing Your Health Insurance Claim Form
Obtain Itemized Receipts
You will need to ask your doctor for an itemized bill. An itemized bill lists every service that your doctor provided and gives the cost of each of the services. Make sure any medications or drugs provided during any treatment are listed with itemized costs. Your health insurance company will need you to attach the original itemized bills to the claim form.
Get Your Claim Form
You will need to contact your insurance company to obtain a health insurance claim form or download a copy from their website. Your claim form will also give you additional instructions about what other information they may need from your doctor or healthcare facility. It is best to read through it before beginning.
Once you have your claim form filled out and your itemized bills from your doctor, don't forget to make copies of everything. It will eliminate any errors that may be made in the claim process and make it easier for you to re-file your health insurance claim if it gets lost. You may 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
To make sure everything is completely accurate, call your health insurance company and tell them you are about to send in your health insurance claim form. Review with them all the paperwork you have and ask them if there is anything else you need. Also, ask your insurance company how long should you expect to wait for your claim to be paid and mark that date on your calendar. Once you have everything in order, send out the claim form to your insurance company. The address to send the claim form should be on the claim form itself. 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 time frame given to you.
Submit Your Health Insurance Claim Form Online
Before you start filling in the paperwork and heading to the post office, always check your health insurance company's website.
Many insurance companies now 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 if your healthcare plan is not through your employer, contact your health plan insurer directly to find out if they have access to their services online.
Usually, if you go to your insurance company website, there will be a place where you can log on. If you do not have the information, call them and have them help you set it up.
You may also be able to fill information online and submit at least part of the claim via your health insurance company website. If they do not offer full online submission, you may be able to start the claim and just mail in the supplementary documents with the associated reference number.
Advantages of Making Your Health Insurance Claim Electronically Through a Website
The benefit of submitting claims online is that the payment for your claim may be significantly faster, in some cases, 24 hours. Getting your payment processed as fast as possible is worth going through setting up an account to manage your services online. There is also a good chance that when you fill in your form online, you will also immediately see what portion of the 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 to understand the related health insurance out-of-pocket expenses, or what kind of refund or payment your benefits plan will pay.
When You Have to Submit Your Health Insurance Claim by Mail
In some cases, a health insurance provider may not offer online submission or may limit online forms to specific services. In those cases, you may have to print a claim form, fill in 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 will vary, depending on the company, but it should take two to four weeks. 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 may have been an error that it was denied, or more information may be needed.
Is health insurance claim reimbursement taxable?
In most cases, health insurance claim reimbursement is not taxable and doesn't need to be claimed on your taxes. You should check with your tax advisor about your situation.