How to Get Your Health Insurance Claim Processed

July 5, 2018 Health A-Z

Filing a health insurance claim is not a complicated process once you understand every necessary step you need to take. A health insurance claim means you are asking your provider to reimburse you for medical/health services you have obtained.

The claim is filed by your health provider in case the doctor is part of the provider’s circle. If not then you need to handle health insurance claims at your end.

How to make your health insurance claim?

The steps to file your health insurance claim are fairly simple.

When the bill is directly sent by your clinic/hospital

After you make the payment, the doctor/hospital’s billing center sends the bill to your insurance provider. The process is now electronic and the bills can be sent through emails. The doctor will send the bill along with other details such as the patient’s information and services rendered.
The insurer will compare the bill against the benefits it offers and accordingly make the payment.

When you send the bill to your provider

You will need an itemized bill from your doctor to send along, with the claim form. The itemized bill is a list of services your doctor offers along with the cost of each. For the rest, simply follow the directions as provided by your insurance company. You can email them the documents or fill the form through their online system if available.

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You will need to fill in information like your insurance number, the receiver of the service (you or your co-dependent such as your spouse or children), date of service provided by the doctor etc. in the claim form. You can ask the insurance company to send you the claim form or download it from the provider’s website. Some companies may still choose the traditional mail option for claims. So, always find out in advance how your provider needs you to send the claim form – mail, email, or through their company website.

Keep the reference number you will be provided when you submit the form. It may come in handy in case your claim refund is delayed.

What to do when the claim is denied?

First, it is important to have all the necessary information about your policy at your disposal before you seek a medical service. Otherwise you may end up with a huge bill that you might need to pay using your own money.

Health insurance claims can be denied for two reasons – errors or the provider doesn’t cover a particular service.

Find out in advance about the time frame to file review requests with your provider. In case your claim has been denied, call or write to your provider for an explanation. If it was due to an administrative or system error, the provider will rectify it soon enough. If not, then you will have to pay the bill yourself. The provider may have denied health claims due to errors on your part while filling out the form. It may be also be due to the fact that you missed the deadline to file the claim. In such cases, it is better to talk to the provider’s customer service and have the problems rectified as soon as possible.

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In case, you have any confusion about submitting the form, it is better to call your provider for information rather than submit an erroneous or incomplete document. The insurance company will be happy to provide you with the information you need as it will save them a lot of hassle as well.