How To Submit A Health Insurance Claim

Before submitting a health insurance claim, it’s important to understand what exactly a health insurance claim is.

A health insurance claim is when a person requests a reimbursement or direct payment for medical services that they’ve already obtained. This is usually done by submitting a claim via form or request, and there are 2 ways in which to do this. 

The first and most convenient way is when your medical service provider submits the claim directly to your insurance company, electronically.

The second way is by completing a claim form and sending off the paperwork to your insurance company yourself. This can happen if your health service provider can’t file this on your behalf, and means you will have to file the claim to request payment for the services you received.

 When You Need to Request a Reimbursement

Although it does depend on the insurance company, most offer different options than the traditional mail-based health insurance claim methods. People usually request a reimbursement when they have to pay hospital bills on their own & then get reimbursed from their insurance companies.

Here are some steps you’ll need to take, along with some helpful tips, on submitting your insurance claim form:

You’ll need a claim form.

In order to obtain this you’ll need to contact your insurance company or download a copy from the website. The claim form will also give instructions about what other info might be needed from your doctor or healthcare facility.

You’ll need to make copies.

Once the claim form has been filled out and you’ve organised the itemized bills from your doctor, you will then need to make copies of all the documents. This way you can stay organised and avoid any errors or missing items, making for a smooth process.

Make final reviews and send.

Before you send anything off, make sure you call your insurance company to make sure everything is accurate. You will both review all paperwork and make sure there is nothing left outstanding, and this point is the perfect opportunity to enquire about how long the process can be.

Once this has all been sorted and you have everything in order, your form is all ready to be send out to your insurance company – and be ready to contact your insurance company if there are any delays. 

Many health insurance claims can be submitted online, so it’s always useful to check your insurance company’s website before you start filling in paperwork. You can ask your employer if your health plan offers this option (provided you access private healthcare through your place of employment). If not, you can contact your insurer directly to find out if services can be accessed online.

What are the Costs of Claiming?

Excess

Your insurer typically pays the bill for you directly to the treatment provider, but in some cases you may need to pay an excess. This amount is usually agreed when you take out your policy, and is usually between £50 and £1,000.

Normally this is paid directly to the treatment provider, for example; if your excess is £100 and you claim for a £300 appointment, you will have to pay £100 to the facility and your insurer will pay the other £200 to them.

Higher premiums

In some cases making a claim can make your monthly or yearly premiums more expensive when you renew your policy or take a new one out the following year.

This is due to the fact that any illnesses or symptoms you have previously claimed for are known as pre-existing conditions.

What if my claim is rejected?

This can happen if your insurer decides that your policy does not cover the treatment you requested. If this happens, make sure to check your policy documents, in order to work out and be sure of what your medical insurance covers.

If you think they should be able to pay for your treatment, enquire as to why your claim was rejected. You can also complain if you think the decision is wrong.