How to file a health insurance claim in 4 easy steps
Healthcare is one of the fastest-growing economic sectors in the United States. Each year over $8,000 is spent by the average American on healthcare, and a substantial portion of this amount goes to health insurance. People usually buy a health insurance plan in order to save on medical expenses. Here are some types of insurance to consider when choosing a new policy.
This type of insurance is the most straightforward. A client pays a fee to an insurance provider who is responsible for paying for their medical expenses. Usually there is a deductible, and you’ll likely have a coinsurance or co-pay depending on your insurance plan.
Managed care organizations (MCOs)
These organizations are responsible for reducing healthcare costs and increasing health service efficiency. MCOs have a specific network of facilities and doctors. However, the clients may face restrictions regarding where they can go to get treatment. There are three types of MCOs.
Health management organizations
Based on this insurance plan, clients can visit a limited amount of doctors. But the advantage is that they pay a low fee. When a client gets treatment from a doctor outside the network, the expenses will have to be covered out of pocket. This type of insurance is aimed at providing primary care. It is cheap and flexible.
Point of service
This insurance plan also has a network of facilities. You pay a lower fee and your needs are normally fulfilled by in-network specialists. But you usually pay a higher fee, if you need to see an out-of-network specialist.
Preferred provider organization
Preferred provider organizations (PPOs) are similar to the Point of Service Plans. The clients can easily see any specialist, physician or doctor if they pay the whole premium. When they pay less, they are allowed to see only “preferred” doctors from their internal network.
Consumer-driven health plan
This is the newest plan among all MCOs. According to this plan, a client gets all benefits of the PPOs after they pay a certain deductible. Regardless of this high deductible, clients face low premiums and get a “savings account” which is like a retirement fund. Clients are free to put their money into this savings account and cover all out-of-pocket expenses later.
How to submit a health insurance claim
Once you’ve received any treatment, such as purchasing a new pair of glasses or visiting a dentist, your next step is to claim a reimbursement for all these medical expenses. Here is an easy 4-step guide on how to claim this reimbursement.
Obtain all itemized receipts
Before you complete and file your health insurance claim form, you have to collect all itemized receipts from your medical provider. This should include each and every service you’ve received for a certain period of time along with a special code and cost the insurance organization will have to pay. Just contact your medical provider and ask them to send you a receipt at a certain date.
Complete a health insurance claim form 1500
By filling out this form, you provide the insurance company with more details about the illness you are being treated for. This form will help a provider determine if the expenses you claim can be covered by the company or if the expenses are not covered by your insurance plan. If you have any questions on how to fill out a health insurance claim form, you may contact your insurance provider. In this form you have to provide the following information:
- Personal data: name, date of birth, address.
- Insurance information: group number, policy.
- Out-of-pocket expenses that you’ve already paid
- Provider data: the name and address of the doctor.
If there is not enough space on the form to provide all necessary information, you can easily attach as many additional pages as you want.
Make a copy of your health insurance claim form
Before forwarding your completed claim form to your insurance company, make a copy of it for your own records. Also, keep copies of all the receipts you’ve requested from your doctor. This is just a preventive measure.
Send the health insurance claim form to your insurance company
Double check if you have filled out the health insurance claim form correctly. Once you’re sure the form is properly completed, send it to your insurance company. The address of where to send the health insurance claim form must be indicated right on the form. You may also call the company and ask if you need to provide any other documents.
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