HANDLING CLAIMS - FILING A CLAIM

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TIPS ON FILING A HEALTH INSURANCE CLAIM

Study your plan. Make sure you know what is covered. Read the fine print. Remember the old insurance adage: “The large print giveth and the small print taketh away.” Before receiving medical care make your health provider familiar with your plan. Always use your medical ID card when you receive treatment. If your plan requires pre-certification prior to treatment, follow the pre-certification guidelines.

Complete the claim’s form correctly and submit it in a timely manner--no later than 90 days from the day you received medical care. Generally, when receiving medical care in the USA, your insurance company can directly reimburse the medical provider. However, when outside the USA, you will need to pay out-of-pocket expenses and then contact the insurance company for reimbursement. After paying your provider, submit your claim form, bills, and itemized receipts to your insurance company.

When submitting your claim form, list the claims in chronological order on the form starting with the oldest claim. Make sure the date of service and diagnosis is listed on each receipt. Also put the patient’s name on each receipt.