How to file through insurance
In some cases, filing through health insurance can be a lengthy process. At some point you’ve had to complete loads of paperwork at the doctor’s office or pharmacy. It should be easy but a lot of times it isn’t. Why are there so many documents to fill out? Does my insurance carrier even need all of this? What happens once the doctor’s office has my insurance information? Questions like these are quite common but I have to tell you, the time you spend preparing to file a claim through your insurance carrier has its benefits.
What is a medical insurance claim?
A medical insurance claim is a medical bill submitted by health care providers to insurance companies for compensation of services rendered to you.
What is copayment (copay)?
Copayment for medical services is an upfront amount that insurance companies establish before medical services are rendered. Insurance companies use copayments to share the medical expenses with you. It is also used to help prevent unnecessary claims being submitted. Individuals are likely to reconsider seeing the doctor for minute situations when payment is involved. If you are not sure what your copay is for your insurance, contact your insurance provider to find out.
Is your provider in network?
Your medical provider will file the majority of your medical claims. It is best to check with your doctor or service provider to see if they are in network with your particular insurance. If they are not, you will want to know what out of network benefits are available and if the provider will accept them.
Even if your insurance is in network with your medical service provider, still ask your insurance representative to clarify policy benefits if you do not understand them. By doing this you will avoid paying out of pocket for services your insurance carrier does not cover.
As mentioned before, most medical service providers complete the difficult part of submitting claims for you. If that is the case, great! However, if you have to do it yourself follow the steps below.
- Make sure your medical service provider is in network with your insurance carrier.
- Stay organized by keeping records of any receipts, itemized bills and other pertinent information. The medical bill needs to be as detailed as possible. Any services rendered (or that you’re being charged for) by your doctor or medical provider must be listed on this bill. If it is not, your insurance carrier will not cover it. You will want to attach these documents to the appropriate health insurance claim. Always, always keep records for yourself.
- Contact your insurance carrier for a copy of the insurance claim form. You may have the option to download the form from online or have it mailed directly to you. Once you have it, thoroughly review it, complete it and submit it to your insurance carrier.
- If payment is owed to the medical service provider, submit the payment and include the corresponding paperwork in your claim for reimbursement. Some insurance carriers require payment first and reimbursement later. If this is the case, you will need to be as detailed as possible with paperwork, etc.
- Contact your insurance carrier before submitting a claim for a checklist of required paperwork. This will ensure the claim is filed correctly and will minimize the possibility of a denial.