How To File a Health Insurance Claim Form

Filing a health insurance claim means you're requesting reimbursement or direct payment for medical services that you've already received. The way to obtain benefits or payment is by submitting a claim via a specific form or request. There are two ways to submit your health insurance claim.

What Are the Options To File a Health Insurance Claim?

The first way to file a health insurance claim (and the most convenient) is when your medical services provider can submit the claim directly to the insurance company on your behalf. They can do this electronically through the network.

Your other option is to complete the claim form yourself and send the paperwork to the insurance company yourself. This can be necessary if your health service provider is not in the network for your health plan or can't file it on your behalf.

Online Health Insurance Claims: When You Need To Request a Reimbursement

It used to be that you had to submit health insurance claims through the mail, but many companies and medical benefit plans offer a few different options. They can depend on the health insurance company. 

When you go to the doctor or other medical provider and are told that you have to submit your insurance claim form, it means that the doctor or facility doesn't ask the health insurance company to pay for your bill, and you must do it yourself. 

What Kinds of Information Do You Need To File a Health Insurance Claim Form?

You'll have to take certain steps to submit your insurance claim form. First, you must understand your medical bill. You'll also need some basic information to fill out the form.

List of Things on a Health Insurance Claim Form

The claim form should be fairly self-explanatory to fill out. It will ask things like:

• Your insurance policy number, group plan number, or member number
• Who received the services (for example if it was the primary insured or a dependent like a child, spouse, or domestic partner)
• If there is coinsurance or dual coverage
• What was the visit for (accident, worker's compensation), etc.

Four Steps to Filing Your Health Insurance Claim Form

Obtain Itemized Receipts

Ask your doctor for an itemized bill that lists every service that was provided and gives the cost of each of these services. Make sure any medications or drugs that are provided during treatment are listed with itemized costs. Your health insurance company will require that you attach the original itemized bills to the claim form.

Get Your Claim Form

Contact your insurance company to obtain a health insurance claim form or download a copy from their website. The form will also give you additional instructions about what other information the company might need from your doctor or health care facility.

Make Copies of Everything

Don't forget to make copies of everything after you have your claim form filled out and your itemized bills from your doctor. This will eliminate any errors that may be made in the claim process and make it easier for you to refile your health insurance claim if it gets lost.

You might also want to check the billing codes for medical errors and contact your health provider if you need clarification. This step will avoid having your health insurance denied for incorrect information.

Review and Send

Call your health insurance company and tell them you are about to send in your health insurance claim form. Review all the paperwork you have with them and ask if there's anything else you need. Ask how long you should expect to wait for your claim to be paid and mark that date on your calendar.

Send the claim form to your insurance company when you're sure everything is in order. The address should be on the claim form.

Submit Your Health Insurance Claim Form

Check your health insurance company's website before you start filling in the paperwork and heading to the post office,

Submitting Your Claim Online

Many insurance companies offer the possibility to log onto your health and medical benefits plan online. You can ask your employer if your health plan offers this option or contact your health plan insurer directly if your plan isn't through an employer.

You may also be able to fill in the information online and submit at least part of the claim via your health insurance company website. You might be able to start the claim and just mail in the supplementary documents with the associated reference number if they don't offer full online submission.

Advantages of Making Your Claim Through a Website

The benefit of submitting claims online is that the payment for your claim may be significantly faster, as soon as 24 hours in some cases. Getting your payment processed as fast as possible is worth going through the effort of setting up an account to manage your services online.

There's also a good chance that you'll immediately see what portion of your claim is covered, what your coinsurance clause is, and what deductible applies. 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, and what kind of refund or payment your benefits plan will pay.

When You Have To Submit Your Claim by Mail

A health insurance provider may not offer online submission or may limit online forms to specific services. You may have to print a claim form in this case, fill in all the details, and submit it via the mail.

Frequently Asked Questions (FAQs)