Steps You Need to Take to Submit your Health Insurance Claim

health insurance

When you go to a doctor or another healthcare professional, your insurance covers the cost of the visit (or, a part of it). However, to be able to obtain the reimbursement, you need to inform your insurance company of your visit by submitting an insurance claim via a filled in form or request.

You can do this in two ways:

  1. The first and the most convenient way is to have your healthcare provider contact your insurance company directly. This way it is done automatically, and you do not need to do anything anymore.
  2. The other way is by filling in the health insurance form and sending it to your insurance provider yourself.

Interesting to know: Sometimes, you can have coverage both through your insurance provider and your spouse’s. If this is the case, you can get more coverage and will have to pay less out of your pocket. To be able to benefit from this, fill in two request forms and send them to the respective insurance companies.

If your healthcare provider does not submit the insurance claim on your behalf and you need to do it yourself, check with your insurance what their preferred way to get claims from you is. You might have been used to submitting your claims per post but with the advance of technology many insurance providers provide a possibility to submit them online.

Information you need to fill in the insurance claim form:

Insurance claims are usually self-explanatory and do not require expert knowledge to fill them in. Here are the usual fields:

  • Your insurance policy number, member number or group plan number
  • Who received medical services (the primary insured person or a dependent like a child, spouse or domestic partner)
  • Whether there is co-insurance or dual coverage
  • The reason for the visit (accident, illness), etc.?

Steps for filing your insurance claim form

  1. Ask for itemized bills. After your visit, ask your doctor to give you an itemized receipt. An itemized bill lists every service your doctor provided with a cost of each service. Make sure any medications that were used during treatment are clearly listed and itemized as necessary. Your insurance provider will also need you to attach the original bills to the filled in form.
  2. Make sure you have your claim form. Contact your insurance company to provide their claim form to you or download it from their website. This form will have all the information your insurance might need to be able to make the reimbursement.
  3. Make copies of everything. Once you have your itemized bills and have filled out the claim form, make copies of everything. It’s a good habit to have as it will help you avoid any misunderstanding should things get lost on the way and having copies will help you refile the claim form in case it does get lost. You might also want to check the billing codes for medical errors and contact your doctor for clarification, if necessary.
  4. Review your application and send it. To make sure your documents are correct, call your insurance and mention you are about to send an insurance claim. You can usually review your claim with them, thus making sure you did not miss anything and that your data is correct. Ask them when you could expect the payment and mark the date in your calendar. Once you have everything in order, send your claim out to the insurance company. The address is usually indicated on the form itself. Check if the claim has been paid off on the date you marked in your calendar and contact your insurance again if this is not the case.

Submitting your insurance claim by mail and its advantages

Before filling in any papers, head to your insurance company’s website and check if they offer a possibility to submit your claims online. You can ask your employer if the insurer provides such an option and if you are not insured through your employer, check with your insurance provider directly whether you can access their healthcare services online.

Usually, when you go to your insurance company’s website there will be a place where you can log in. It is often worth it to go through the account creation process as in many cases you will not only be able to access your file but also file insurance claims, see if there are any missing documents that still need to be provided as well as the status of your reimbursements. Sometimes, you can file only part of the claim online and mail the original receipts later.

One of the main advantages, why it is more convenient to submit your insurance claims online, is that your claim is processed so much faster. You can sometimes get your reimbursement as fast as in 24h. There’s also a high chance that when you file your claim you will see what portion of it is covered, what your co-insurance clause is and what deductible applies, if any. You will also get an idea of what you might have to pay out of your pocket, which is very helpful.

 

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