How to Trace an Unpaid Insurance Claim

When tracing your insurance claims, you will need to have your member ID number and the dates of services of the claims you are tracing. Claims information is typically found on the health insurers' confidential website, on your Explanation of Benefits (EOB) statements or by calling your insurer or doctor's office. With automation of claims processing and required documentation of claims decisions, tracing an unpaid claim does not require a significant amount of sleuthing. Your doctor's office or hospital's billing department can also assist you in tracing unpaid claims.

Things You'll Need

• Member ID Number

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Instructions

• 1

  Review your claims history on your health insurer's website. Most major carriers allow you to access your claims information through the member portal of their website. You will need to register and create a password, giving you access to search your claims. You may be able to see both paid and unpaid claims.

• 2

  Read your EOB statements carefully to determine how and when claims were paid or denied. If a portion of the claim was paid or the claims were completely denied, the EOB will list the dollar amount paid and reasons for the denial. The EOB may also include your portion of the unpaid claim and list what you owe. If you have a co-insurance, you will be responsible for paying your share of the cost after the insurer pays.

• 3

  Call your insurer to trace unpaid claims. Using the number on the back of your ID card, call and select the option to speak with someone regarding claims, if this is an option. If not, select the option for members and you will reach a claims representative. The representative will provide you with full claims data, by date of service, including what services were submitted, what was paid and what was unpaid. She can also tell you why claims were unpaid and if denied, can give you appeal rights if you wish to appeal the denial.

• 4

  Call the billing department of your provider's office, hospital, lab or other facility to inquire if they have submitted claims. If you are receiving a bill from your doctor, hospital, lab or facility, it may be because they did not bill your insurance company first. Providers that participate in insurance plan networks are obligated to bill the insurance company before billing the patient, minus any deductibles or co-pays. You may also be receiving a bill for your portion of the co-insurance. Your provider will likely assist you in tracing any unpaid claims.