Health Insurance: Claims

Filing a claim with an insurer starts the process of getting health care paid for. Life will be easier, and you will maximize use of your insurance, if you know:

• Whether the provider files the claim or you have to
• If you have to file a claim, how to do it
• What happens if you have more than one health insurance plan
• How to appeal if an insurer denies your claim.  

When you file a health claim:

• Be sure to follow the insurance company's procedures and requirements. A claim may be rejected if you do not follow the requirements.
  • For instance, pay attention to the dates by which claims must be filed. 
  • Also note requirements about  where and how claims are to be presented. 
• Keep a photocopy of everything you submit to an insurer (preferably in a file with all the other papers relating to your health plan).
• Keep track of what has been paid, and what has not been paid. 
  • This can be done as simply as keeping two folders. One folder has a copy of each submitted claim. Claims are moved to the other folder when they are paid. 
  • You can also keep track of claims on your computer in a word processing document or on a spread sheet by cutting and pasting claim information from one place to another. You can also manage claims with computer software such as Quicken's Medical Expense Manager  

There are many stories about health insurers saying "no" hoping that people will not know enough to push the issue. Sometimes the company says "no" because the paperwork hasn't caught up yet.

If a claim is turned down by the insurance company: appeal - and keep appealing. (For "how to" information, see the document in "To Learn More.") Persistence pays off. It is worth the effort to follow up and to keep appealing. We are talking about your health, and possibly your life.

NOTE: If you have a question whether a medical expense is covered by your insurance, file the claim. Let the insurer tell you if it is not covered. Ask why.

Information about each of these subjects is contained in the other sections of this document.

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