A How-To Guide for Filing an Insurance Claim

Many people are confused about health insurance, and it doesn’t help that there are so many different types of health insurance plans on the market. It can be doubly baffling when you have to file a health insurance claim — especially if you’ve never dealt with the claims process before. 

If you’re new to the idea of appealing a health insurance claim, you’re hardly alone. Many healthcare providers handle all claims internally, which means most consumers don’t get involved in the process. Nevertheless, there are certain situations where you might need to handle a claim on your own. 

Let’s say that your health insurer refuses to pay for healthcare expenses you believe should be covered. You have the legal right to appeal the decision and ask for it to be reviewed by a third party or reconsidered by the insurer. 

Here’s another scenario that might lead you to make a claim: You believe there’s been a mistake on an existing claim. Despite their best efforts, healthcare providers, hospitals, clinics, and insurers can make mistakes at any stage in the claims processing cycle. To correct the error, you may end up filing a health insurance claim on your own. 

Avoiding Common Pitfalls When Filing Claims 

Because many people who file health insurance claims have never done so before, they run a higher risk of mix-ups in three key areas: time, knowledge, and organization. Here are a few common mistakes: 

• Waiting too long to take action. This is the time component. Most insurance companies will only accept original medical claims or appeals for a certain period, so don’t delay! After you’ve gotten treatment and your health (or the health of your insured loved one) is stabilized, start working on your claim ASAP. 
• Misunderstanding policy terms. Here’s where knowledge comes in. Before gathering information for your claim, you should first know whether your insurance policy covers the services or treatment you received. Read your coverage policy carefully to make sure you have a complete understanding of any guidelines, regulations, restrictions, and rules. 

• Not collecting documentation. And last but not least, organization. When it comes to filing a health insurance claim, documentation is required. Without the proper documents to bolster your claim, you won’t get an acceptance.

Now that you know these common mistakes, you can take the proper steps to file a claim in the most efficient way possible: 

Step 1: Collect itemized receipts.

Unless you already have itemized receipts from each provider you’ve visited, you’ll need to request them. What is the difference between an itemized bill and a general receipt? An itemized receipt will break down every service and medication. It should list the costs associated with each item on the bill. This itemization helps your health insurer understand the treatment you received more comprehensively. 

Step 2: Get an official claim form. 

Every insurance company uses its own preferred health insurance claim form. Your job is to either ask your insurer to send you one or download a copy from the company’s website. Most large insurance companies make accessing forms fairly straightforward, although finding the right one can sometimes be tricky. Be sure to read any instructions included with the claim form before you enter any information. 

Step 3: Fill out the health insurance claim form. 

This step typically involves just following directions. Feel free to make phone calls to the insurance company if you have questions. For example, you might be confused about billing codes — or perhaps you need extra clarification on the wording of a section. It’s better to get answers upfront instead of submitting an error-filled claim. 

Step 4: Make copies of the health insurance claim form and itemized receipts. 

Once your form is complete, you’ll want to attach any itemized bills and other documentation to it. But before you send everything away in the mail, make a copy for your records. This should provide an extra layer of protection in case the claim gets questioned or lost. 

Step 5: Be proactive. 

At this point, you’ll want to call your insurance company to let them know the claim form is on its way. When you speak with a representative, tell them about the paperwork you’re sending to ensure you haven’t missed anything. You may also want to ask how long you should expect to wait for the claim to be answered or paid. Be sure to add that date to your calendar so you can follow up. Then, you’re good to go! 

It’s easy to get confused about health insurance, particularly when your insurer won’t cover certain healthcare expenses. But before you get stressed out, know that you can submit a claim and resolve the issue. It’s your right as a consumer — and it’s not nearly as hard as you probably thought it might be. 

At Health Karma, we believe that good healthcare starts with understanding it. To discover more insights to get the most out of your healthcare, click here.