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An insurance claim is a request for your insurance company to pay for something your insurance covers, such as a trip to the emergency room. This usually involves completing a form and requesting payment, then submitting the form to the insurance company.

The process to submit claims may vary, depending on the situation. Understanding the process will help eliminate the stress of submitting a claim and avoiding payment delays. 

Use In-Network Providers When Possible

Your insurance plan has a list of doctors, hospitals, and clinics that are contracted directly with the insurance company. These providers are called in-network providers, and they accept payment directly from the insurance company and send claims to your insurance company. This means you do not have to submit the claim yourself.

If you do need to submit the claim yourself, however, here are five steps to ensure it is filed correctly and approved.

1. Ask for an Itemized Receipt

If you do have to file the claim yourself, you must provide an itemized receipt from your medical provider. This receipt lists all services received, the cost of each, and a special medical code that the insurance company uses when reviewing your claim. 

To obtain a copy of the receipt, simply call the medical provider and ask for the documentation because you are filing a claim. 

2. Complete a Claim Form

Your insurance carrier will provide you with a claim form, often available to download from their website. Simply complete the form, which asks for details about the illness or accident, insurance information, and any expenses already paid towards service. 

The form should include detailed instructions, including where to send the form once it is completed. If you have specific questions about the form, your insurance company can help. 

3. Make a Copy

Always, always, always make and keep a copy of any documentation you send to the insurance company; include the date you sent it and the method (such as email, fax, or through the postal service). 

You may need to resend documentation at a later date and you will benefit from having an accurate copy of your submitted documents. 

4. Call Your Insurance Company

Once you have your receipt, completed the claim form, and have personal copies of each, call your insurance company. Let them know you are filing a claim, review the paperwork in hand, and ask them if there is anything else you need to send to complete the filing of the claim. Confirm how and where to send the paperwork. 

Most insurance companies prefer claims to be submitted via email, or directly through their website. Finally, ask them how long it will take for the claim to be paid. Write down the date of this call, the time, the name of the person with whom you spoke, and the details of your conversation. 

5. Follow Up

It is always a good idea to follow up in a week or two to confirm that your documents were received and that the claim is being processed. Your insurance company may request more information or documentation from you during the processing of your claim, so be ready to provide more details at any time. 

Common Causes for Denial of Claims

The following errors could lead to your claim being denied.

• Clerical errors: Misspelling of names or addresses, typos, entering the wrong medical code, or date of service. Be sure to triple-check all the information on the forms you are submitting. 
• Failure to meet the submission deadline: Every insurance company has a different deadline, but be sure to make note of it. Claims typically need to be submitted within 90 days of a medical visit, but be sure to familiarize yourself with your company’s policy. 
• Medical necessity is deemed insufficient: Claims are sometimes denied when the insurer does not consider the medical visit or procedure as appropriate or necessary. 

If your claim is denied for any reason, there is typically a process for appeal or an opportunity for resubmission. 

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