How Do I File a Health Insurance Claim?

Did you know that you might be filing dozens of health insurance claims every year without even knowing it? Unlike life, auto or business insurance, filing a health insurance claim is as simple as visiting your doctor. But, in the event you do have to file a claim yourself, there are a few things you will need to know. Let’s discuss the basics of health insurance claims now.

Basic Filing—The first time you visited your regular physician, and every year upon your insurance renewal, you provide your doctor’s administrative assistants with a copy of your health insurance card(s). Thereafter, every time you visit your doctor, you may pay a co-payment, but the doctor’s office files all of your claim work for you. Unless there is a problem, you may never be alerted to the claim or resolution of payment at all.

Reimbursement Claims—Occasionally, you may have to file your own insurance claim. This is especially true if you have double-coverage and must request reimbursement on an unpaid prescription through your secondary insurance. In this case, the forms are relatively simple and should take you no more than 5 minutes to complete.

For Larger Claims—In the event that you ever need to file, or re-file should your initial claim be denied, a claim with your insurance company, there are some things you will need to know.

Group Insurance—If you have group insurance, you should contact your benefits administrator and talk to them about the reasons for your claim. They may be able to help you expedite or clarify your claim.

Ask Questions—If there is a problem with your claim, you should ask for an explanation from your insurance company. Always get everything from your insurance company in writing and keep it all in one file, along with the names of everyone at the insurance company, doctor’s office, etc. that you had contact with in regards to the services you received as well as the claim.

Write a Letter—If you feel that your claim is being unfairly denied, you should write a letter of concern or complaint to your insurance company, agent and administrator, if you have one.

Have All of Your Information Handy—If you find you need to file an insurance claim, or complaint, you need to know your policy and have it handy. Some of the things you should highlight and have complete understanding of, for your own benefit, are: your covered benefits (remember that medical benefits are different from medical necessities), exclusions, limitations, and you insurance company’s policy regarding claims procedures.

Remember, your policy and the handbook that comes with it, no matter how large or small, comprise the rulebook that your insurance company, and you, must follow not matter what. Don’t hesitate to mark up your handbook or a Xerox copy of your policy—do everything you can to help yourself and make your claims process run smoothly.