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Submitting a Claim

Sometimes it is not enough to just give your insurance ID card for guaranteed direct billing, sometimes you need to file and submit a claim. Through this process, you get reimbursed for any doctor’s visits you have paid out of pocket and also you make sure your medical bills are paid for promptly. Remember to read your policy to see your benefits, and how/when your medical bills will be paid for.

 

Below you will find 5 easy steps, to make your life easier when submitting a claim to your insurance company.

 

  1. Collect Receipts: To file a claim, the first thing you need to do is get an itemized bill from your doctor. In this bill the doctor will list all the services you received, along with the price and a code the insurance company will use. After you have that bill – call your provider to let them know you will be filling a claim. From there, they will ask for itemized receipt, your full name and any other information they deem necessary.
  2. Claim Form: This form is used by the insurance company to get more detailed information about the accident or illness. The form will help them determine whether the expenses you are claiming are refund for are covered in your insurance plan or not. The more information you give on these forms the better. Keep in mind, that each form will have all the directions you need to follow plus the place where you should mail said form. If you have any questions about anything on the form, please contact your insurance agent.

Typical sections of a claim form:

  • Personal information (name, date of birth, address, etc.)
  • Insurance information (policy #, group #, etc.)
  • Reasons and background information on the condition
  • Provider information (doctors name, address, telephone #, etc.)
  • Out of pocket expenses, that have already been paid
  1. Make copies: Just to be extra safe, it is always a good idea to make extra copies of all the paper work you are submitting. Keep all the copies of the claim forms, receipts, bills, etc. in case there is any complication with the claim.
  2. Send the form: When all the documents needed are complete, in order and ready to be sent, call your company first. Let them know that you will be sending a claim, tell them about all the documentation you are sending and review the documentation with them. Take the time to ask if they will require any additional paperwork from you, and about how long you should be waiting for the claim to be paid.

When you are 100% sure that you have everything you need, and everything is in order, send your claim form. If you need an address check the claim form, it is normally stated there. Usually, you will be required to submit your claims through mail, but some companies will accept through fax/email. Please contact your agent with any questions or uncertainties you may have.

  1. Wait: Once you have submitted all the documentation, there is nothing else to do, except to wait. Keep in mind the date the company gave you when you called to let them know you were filling a claim. If you do not get a payment within the frame of time given to you, please contact the company or your agent. Remember, whenever you talk to someone, write down the person’s name, the time, the date and any information you deem relevant; this will serve as proof if there are any later complications.

 

Keep in mind, that your insurance company may ask for additional documentation at any time through the process. Given this, it is important that you stay on top of the process. If you have any questions such as how to submit a claim, claim status, or any other, please contact your insurance company.

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