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- There are two primary ways of submitting a health insurance claim: online and by mail
- Begin by obtaining itemized receipts
- Obtain the proper claim form for your specific health insurance company
- Make copies of everything that you plan to submit to the health insurance company
- Review everything to make sure it is correct prior to filing
Health insurance is meant to provide both basic and comprehensive medical services when you need them. Even so, there are times when you must file a health insurance claim form in order to receive the benefits that are rightfully due to you. You might be in a location where you must pay for services rendered out-of-pocket and then submit a claim in order to get reimbursed.
In other instances, you might have received a direct payment for the medical services that you have obtained, but now must go back and file a claim form clarifying exactly why you qualified for those services in the first place. In the end, a health insurance claim form should be properly filled out and filed in order to streamline the process.
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When You Should File a Health Insurance Claim Form
The most common way to obtain payments for your health insurance benefits is to submit a claim form or a request for benefits. This is often conveniently accomplished when the medical provider you received your services at submits the claim directly to the health insurance company via electronic means. This leaves you out of the process. You just pay your co-pay (if you have one) and then go on your way.
There are times, however, when you will need to file for the benefits yourself by submitting a claim form and the corresponding documentation yourself. This might be because the provider you went to for your medical services is outside of the provider network accepted by your health insurance company, in which case they cannot file a claim for you.
In this situation, you will need to file the claim form and request to receive payment for the medical services you rightfully received under the terms of your policy.
Two Most Common Ways of Filing Your Health Insurance Claim
There are two primary methods available to you today to file your health insurance claim. They are:
- Online via electronic transmission
- By Mail
Filing Your Claim Electronically Online
In the past, the only way to submit health insurance claim forms was by mail. While that option is still available to you today, advances in technology have allowed for other ways to submit the documentation necessary for health insurance providers to examine and approve your claim.
If a doctor, hospital, or other type of medical provider informs you that you must submit your own claim for insurance benefits, that means that they do not have the capacity to request reimbursement from the insurance company on their own. You will need to take care of that if you wish to receive your money back.
Many insurance companies offer their clients the opportunity to submit claims online. You will want to start there. Look at your provider’s website in order to determine if this option is available to you, as it is probably the most convenient and fastest way to submit your claim and get your money.
You will likely need to login to the site using your own personal information, so the first time you do this you may need to set up a unique username and password.
Once you have access to your insurance providers online portal, you will quite possibly be able to complete much of the information required for your claim right there.
At the very least, you will be able to submit part of the claim via the website. This will enable your file to be opened while you then submit the required documentation via mail.
Other providers will allow you to submit the entire claim and any corresponding documentation online, which is an even faster way to get a response. When you submit your claim online, you will be able to monitor its progress and be able to see if everything has been received and is in the process of being reviewed. You will even be notified when claims are going to be paid.
In many cases, you can get a response to your claim submitted online within 24 hours. Payments will then be processed as quickly as possible, without having to wait for the mail to go back and forth. If only part of your claim is covered under your specific insurance policy, you will also be able to find out what that is online.
You will be notified of any coinsurance clauses you might have and any deductibles that you are expected to pay before your claim is honored. This is a way to know what you out of pocket expenses are so that you can plan accordingly.
Filing Your Claim By Mail
There are many health insurance companies that still do not allow for claim forms to be submitted electronically. Many people also do not wish to complete the process online, so mail is an option that is still available.
If either of these cases apply to you, you will need to print out a health insurance claim form, fill in all of the necessary details, enclose the required documentation, and then send it off via the postal service.
Filing Your Health Insurance Claim Form Step-by-Step
To begin, you will want to have itemized receipts. If you know that you will need to submit a claim for medical services that you have obtained, you will want to ask the facility for a detailed and itemized bill. This will list out each and every service that your doctor or healthcare provider performed for you, along with the cost associated with each.
This includes all medications that were provided to during treatment, so make sure those are clearly itemized as well along with associated costs. You will need to submit the original bills to the claim form, but remember to make copies for your records.
To obtain your claim form, you can contact your insurance company and have one mailed to you, or you can look online to see if you can download and print one directly from your provider’s website.
The claim form itself is fairly self-explanatory. Just take your time in filling it out, make sure every blank is filled in correctly, and do your best to make it as legible as possible. You will be asked for such items as:
- The policy number of your insurance plan, group plan or member number
- The recipient’s name whose had the services performed (you, your spouse, child, etc.)
- Report if you have any co-insurance or dual coverage
- Explain the purpose of the visit
Remember to make copies of everything, and we do mean everything, no matter how insignificant it might seem to be at the time. While the majority of claims are approved quickly and without any problem, there is always the possibility that your initial claim will be rejected. If it is, you will want to have all of this documentation ready in order to file an appeal.
Having these copies also helps to resolve any mistakes the might be made during the claim process and can help you replace anything associated with your claim that might become lost somewhere along the way.
Conduct one final review before you submit everything. This is true whether you file your claim online or via the mail. It might also be helpful at this stage to call your insurance company just to make sure there is nothing else that they need and to ask them how long you should expect to wait before the claim is resolved and payment issued to you.
If you do not receive a response, either online or via email, by this date then you should contact the insurance company right away to inquire about the status of your claim.
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