The Difference Between an Insurance Claim Form & a Patient Invoice

If you receive medical treatment, whether as a patient in the hospital or as an outpatient, you must deal with a number of statements and invoices. In many cases, you must also file a claim to receive insurance benefits. Although a patient invoice and an insurance claim form both refer to charges you incur for medical treatment, the two documents serve different purposes.

Hospital and Physician Invoice

• After a stay in the hospital or treatment in a doctor's office, the hospital or physician prepares an invoice. The invoice includes an itemized list of charges for the treatments you have received. Other information listed on the invoice includes your admission or treatment date, the date the hospital or physician created the statement, and the total cost of your treatment. If the hospital or physician has a cooperative relationship with your insurance provider, the original invoice will probably show the amount billed to your insurance company. In this case, the hospital or physician does not expect immediate payment from you. However, you are responsible for paying any remaining charges after the insurance company has made its payment. You are responsible for payment in full if the insurance company refuses to pay for your treatment.

Explanation of Benefits

• If you have insurance, in many cases the hospital, outpatient clinic or doctor's office submits its charges for your treatment directly to your insurance company. In this instance, you will receive a statement of benefits that outlines each aspect of your treatment as well as the amount billed to the insurance company and the amount, if any, paid by your insurance company. Even if the statement of benefits shows a balance due, you are not expected to make a payment immediately.

Claim Forms

• In some instances, the hospital or physician will bill you directly rather than submit a claim to your insurance company. This is often true when you travel overseas; many domestic insurance policies do not cover treatment outside the United States, according to the U.S. Department of State. Many foreign hospitals and physicians require you to pay for your medical bills up front and then receive reimbursement from your insurance company. In these cases, you must file a claim form with your insurance company for payment of your eligible medical expenses minus your deductible.

"In Network" Versus "Out of Network" Treatment

• Many insurance companies require you to file a claim form for treatment you receive "out of network," that is, with a health care provider not affiliated with your insurance provider. Out of network treatment often occurs in emergency situations, especially when you travel away from your home within the United States. On the other hand, you often receive significantly discounted charges for receiving treatment from an "in network" physician or medical care facility; these discounts are described on your statement of benefits.