How to Submit a Medical Insurance Claim

Submitting a medical claim is a straight forward exercise if you hold a health insurance policy. Knowing the types of benefits your policy covers, and obtaining proof of your medical expenses, you can ask your insurer to start the process.

Instructions

  • 1

    Itemized Receipts

    You will first need to contact your doctor and request him to prepare an itemized bill which is proof that you have availed medical services. The bill will contain all the necessary information about the patient’s health, and the relevant costs. The insurance company will need that bill in order to process your claim.

  • 2

    Contact the insurance company

    You will need to obtain a health insurance form where you will be filling all the relevant details regarding your medical condition. In most cases, a card will be issued to you by the insurance company which is a proof that you are entitled to acquire their services. Ensure that the policy covers all kinds of medical expenses. Check the policy benefits before going to a doctor. Typically there are three kinds of medical insurances – HMO or health maintenance organization, PPO or Preferred provider organization and POS Point of Service. All will have their respective benefits and limitations so make sure that the policy you have chosen offers maximum coverage.

    Fill out the form by inserting the relevant details, and attach the itemized bill to it. The form will be self explanatory where you will be enlisting the overall payments, date of obtaining the service, the reasons (accident, routine check-up etc) and the details of the health care facility (name of doctor, hospital etc).

  • 3

    Contact Insurance broker

    For private insurances, it is easier to submit claims through an insurance broker, the one who sold you the policy. One can directly contact the customer service department of the insurance company which can guide you through the relevant process but preferably, asking your insurance broker to help you out will save plenty of your time.

  • 4

    Review carefully

    Having gathered all the documents, review the insurance claim for any errors or missing paperwork. You can ask the health care service to help you out as well before submitting the form. Ask them how long will it take for the claim to process. Periodically inquire for the status of your claim. In most cases, the insurance company will set a date or will contact you themselves.

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