A Step-By-Step Guide To Filing Medical Insurance Claims

When you see a doctor or need healthcare services, the provider you see files a claim with your insurance company. However, there may be times when you need to file a health insurance claim yourself. This means you need to let your health insurance company know what services you received, where and for how much. You may need to pay your copay, coinsurance or deductible for the service at the time and then your insurance company will reimburse you for covered portions. When you receive care within your plan's network, the service provider handles the filing for you.

Claim form - fill out and submit with itemized bill and supporting documents

When filing a medical insurance claim, you will need to fill out a claim form specific to your health plan. This form is usually available on the website of your insurance company. You will also need to submit an itemized bill from your doctor, supplier, or other healthcare provider. Make a copy of every single document you receive and put it into a file specifically marked for your claim. You will also need to include any supporting documents related to your claim, such as notes from your doctor.

When filling out the claim form, you will need to provide your insurance policy number, member number, or group plan number. You will also need to include the name of the patient receiving medical treatment and whether or not you have dual coverage or coinsurance. The reason for the treatment should also be included, such as an injury, illness, or preventive care.

If you have Original Medicare, you will need to mail your claim form, itemized bill, and supporting documents to the address for your state, which is listed on the Medicare Administrative Contractor Address Table within the claim form. You can also visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling.

It's important to note that insurance claim forms sometimes get denied or lost, so it's a good idea to keep everything in one place so you can easily find anything you may need later. If your claim is denied, you may need to provide additional documentation or explain why you're submitting the claim, such as if your provider or supplier isn't able to file the claim, refuses to file the claim, or isn't enrolled in Medicare.

Keep records - make copies of all documents and keep them in one place

When filing a medical insurance claim, it is important to keep records of all documents and keep them in one place. This will help you easily find anything you may need later. Make a copy of every single document you receive and put it into a file specifically marked for your claim. Insurance claim forms sometimes get denied or lost. It is important to keep everything in one place so you can easily find anything you may need later.

Find claim form - download from insurance company website

Your insurance company should have a health insurance claim form on their website. This will be a special claim form specific to your health plan. They’ll probably have a way to file the claim online, which is nice. But you should also be prepared to print the claim form and mail it in.

• Your insurance policy number, member number or group plan number
• The name of the patient receiving medical treatment (you, your spouse, your child or anyone covered under your plan)
• Whether or not you have dual coverage or coinsurance
• The reason for the treatment (like an injury, illness or preventive care)

If you get into an accident at work and workers’ compensation covers it, you may need to fill out lots of special paperwork and go through a different insurance company than your normal health insurance company.

Make a copy of every single document you receive and put it into a file specifically marked for your claim. You’ll want to keep everything in one place so you can easily find anything you may need later. Insurance claim forms sometimes get denied or lost.

Pay copay - pay upfront and insurance will reimburse

When you see a doctor or need healthcare services, the provider you see files a claim with your insurance company. You pay your portion and then the doctor's office handles the rest. However, there may be times when you need to file a health insurance claim yourself. This means you need to let your health insurance company know what services you received, where and for how much. You may need to pay your copay, coinsurance or deductible for the service at the time and then your insurance company will reimburse you for covered portions. When you receive care within your plan's network, the service provider handles the filing for you.

You can find the claim form on your insurance company's website. This will be a special claim form specific to your health plan. They’ll probably have a way to file the claim online, which is nice. But you should also be prepared to print the claim form and mail it in. Here are some things you may need to include on the form:

• Your insurance policy number, member number or group plan number
• The name of the patient receiving medical treatment (you, your spouse, your child or anyone covered under your plan)
• Whether or not you have dual coverage or coinsurance
• The reason for the treatment (like an injury, illness or preventive care)

Make a copy of every single document you receive and put it into a file specifically marked for your claim. You’ll want to keep everything in one place so you can easily find anything you may need later. Insurance claim forms sometimes get denied or lost.

Mail claim - send by post to specific address

If you have Original Medicare, you'll need to mail your claim form, itemized bill and supporting documents to the address for your state, which is listed on the Medicare Administrative Contractor Address Table within the claim form.

You can also mail your claim to your insurance company, which should have a health insurance claim form on their website. This will be a special claim form specific to your health plan. They'll probably have a way to file the claim online, which is nice. But you should also be prepared to print the claim form and mail it in.

• Your insurance policy number, member number or group plan number
• The name of the patient receiving medical treatment (you, your spouse, your child or anyone covered under your plan)
• Whether or not you have dual coverage or coinsurance
• The reason for the treatment (like an injury, illness or preventive care)

Make a copy of every single document you receive and put it into a file specifically marked for your claim. You’ll want to keep everything in one place so you can easily find anything you may need later. Insurance claim forms sometimes get denied or lost.

Frequently asked questions