How to Process a Medical Insurance Claim

"According to Chartered Life Underwriter Jacques Chambers, dealing with medical insurance and what medical expenses it covers can be a complicated and stressful process." (See Reference 1.) When claims are not handled correctly, major financial problems can result.

By taking an active role in how your medical treatment is authorized and paid for, you can minimize medical insurance claim problems.

Things You'll Need

• Itemized bill
• Paper clips
• Claim form
• Check
• Medical insurance policy
• Telephone
• Computer with Internet access
• Stamps
• Hospital bills
• Prescription receipts
• Correspondence
• Pen
• Paper
• Envelopes

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Instructions

Preparing Your Claim

• 1

  Request an itemized bill from your doctor's office.

• 2

  Check your medical insurance policy to see which treatments are covered. If you have questions, call the claims representative at your insurer's office.

• 3

  Call your medical insurer and ask for a claim form. Fill out the claim form and attach it to the itemized bill.

• 4

  Pay expenses that are not covered, such as copayments and deductibles, before you file your claim.

• 5

  Copy your claim form, receipts and all correspondence related to your claim, and mail to your insurer.

Monitoring Your Claim

• 6

  Ask your insurer how long the claims process usually takes.

• 7

  If you haven't heard from your insurer within a certain period of time, call and request an update on your claim.

• 8

  If your claim is denied, call the claims manager at your insurer's office and ask them for an appeal or a redetermination.

• 9

  If you've unsuccessfully appealed your claim, call your State Insurance Commissioner and ask for a case review.