Finding a Doctor in the United States: Step by Step Guide to Filing an Insurance Claim

Step by Step Guide to Filing an Insurance Claim

• • Claim Form 
    • Your insurance company will have a health insurance claim form on their website
      • You will be able to submit it online or will have to print the claim and mail it
    • On your form, you will need to include
      • Insurance policy number
      • Member number or group plan number
      • Information on the patient receiving medical treatment
      • If you have dual coverage or coinsurance
      • The reason for treatment
        • If you get into an accident at work and worker’s compensation covers it, you will need to fill out separate paperwork and go through a different insurance company 
        • This is also true if you get in an auto accident or because of negligence (like falling inside a business on wet floors with no sign)
  • Itemized bill and receipts
    • Your itemized bill should detail every service provided including
      • Surgery
      • Medications
      • Radiology exams (X-rays, MRI’s, CT scans)
      • Lab tests like blood work or urine tests
      • Examinations
      • Durable medical equipment (braces and crutches)
      • Cardiovascular tests (EKGs and echocardiograms)
        • If your doctor billed it, it should be included in the list. Each item should be on a separate line and include a code for each procedure
  • Make copies of every document
    • Make copies of documents (all documents) and put them in a file marked for your claim
      • Disputes may happen, so by having copies you can resolve the problem quicker
  • File your claim
    • Can be done online or by mail
    • You can contact your insurance company who will walk you through the submission process