5 Tips for Filing a Health Insurance Claim

5 Tips for Filing a Health Insurance Claim

A health insurance claim is a form that you fill out to request reimbursement or direct payments for medical treatment. Once you fill out the form, the insurance company processes the request, assesses your claim, and decides how much to pay out for services you received. Although the claims process is simple, multiple issues determine if the insurer pays out and how much reimbursement you receive.

If you have questions while filling out your health insurance claim form, you may want to speak with your health insurance broker, who can guide you through the process. Working with an insurance professional can help you avoid any mistakes that could affect your health insurance claim. Below are some tips for filing a health insurance claim. If you have any further questions, contact Insurance Enterprise today.

Tip #1: Know Your Filing Options

There are two main ways to file a health insurance claim.

1. File Directly to the Insurer

The first way to file your health insurance claim is to fill out the paperwork and send it directly to the insurance company. If your health care provider is not in your network, you will likely have to go this route to receive reimbursement for your treatment or medical services. Filing can be a hassle, but you may get your reimbursement back more quickly.

2. File Through Your Medical Provider

The second option for filing your health insurance claim is to file through your provider. Your doctor can fill out the paperwork and send it to the insurance company. If the provider is in your network, they may file the claim electronically to speed up the process. Filing the claim through your provider is more convenient, but the claim may take longer to process.

Tip #2: Understand the Health Insurance Claim Form

Every insurer has its health insurance claim form. However, almost every claim form requests the following information:

  • Your insurance policy number, group plan number, or member number
  • Name of the person on the policy that received treatment
  • If there is coinsurance or dual coverage
  • The purpose of the doctor visit

You may also need to fill out a detailed explanation of your condition or accident and the treatment you received. Make sure you read through and understand the claim form before filling it out. If you have any questions, you should consult your health insurance broker. They can guide you through the claims process.

Tip #3: Gather All Necessary Documents

To verify your claim, you or your physician will need to provide documentation of your condition and the treatment or services you received. All documents need to be complete and accurate. Otherwise, the insurance company may reject your claim and tell you to send the right documents. Poor documentation can delay the process or keep you from getting a full reimbursement.

Documents may include medical reports, invoices, or receipts. Make sure you keep all documents regardless of how insignificant your treatment may be. You may need to recall old paperwork from the previous treatment to verify your current condition or justify your current treatment. Make sure any medications or drugs provided during any treatment are listed with itemized costs. Your health insurance company will need you to attach the original itemized bills to the claim form.

Tip #4: Make Copies and Review Your Claim

Make sure you are thorough in your work. The slightest mistake could lead to a claim rejection or a delay in the process. Double-check your work and make sure that all information is accurate and current. If you need someone else to check your claim, you can always contact your health insurance broker to go over the documents.

If you fill out the claim yourself, make a copy of the claim and all other paperwork and keep it in a safe place. If your doctor fills out the claim, ask for a copy of the original claim and all associated documents. Doing so can help you avoid any problems.

Tip #5: File Your Claim Electronically

When you file your claim electronically, the payment for your claim may arrive significantly faster, in some cases, 24 hours. Getting your payment processed as fast as possible is worth going through setting up an account to manage your services online. There is also a good chance that you will also immediately see what portion of the claim is covered, what your coinsurance clause is, and what deductible applies when you fill in your form online.

Setting up an account to access your health insurance benefits and claims online will help you be better prepared to understand the related health insurance out-of-pocket expenses or what kind of refund or payment your benefits plan will pay.

Contact Insurance Enterprise for Premier Health Insurance

If you have questions about group or individual or group health insurance and need a health insurance quote, contact Insurance Enterprise at 888-350-6605. Speak to a licensed health insurance broker to find out more about how you can get an affordable health insurance plan.