When you have medical care, it’s common for your doctor’s office, hospital or care provider to bill your insurance directly. You only need to pay your co-pay, and anything that’s left over after your health insurance company has paid its share. In some cases, such as with contracted laboratories or diagnostic centers, you may find yourself in the position of having to pay up front for services and then contact your insurance company for reimbursement. It usually goes smoothly, provided you follow the right procedures.
Contact your health care provider and request the form you must use to request reimbursement. Many companies have all of their forms available on their website; check online to see if you can download the form instead of waiting for the mail. If you aren’t sure which form you need, check online for a FAQs section that might explain it, or contact customer service online or by phone.
Collect all of the documentation your insurance provider requires. Typically this will include proof of the medical care you received and how much you had to pay. Make sure the billing code is included on the papers you get from the doctor’s office, since your insurance company is unlikely to process your claim without it.
Fill out the insurance company form and send it, along with all requested proof, to the claims department of your insurance company. Keep a copy of the form and everything you send with it in case it gets lost along the way. Be patient once the paperwork is on its way, since insurance companies are often slow when processing claims.
Things You Will Need
- Paperwork from medical procedures
- Insurance forms
- Avoid unpleasant surprises by checking your policy to make sure you’ve got coverage for anything you’re asking to be reimbursed for. Also take a good look at how much you can expect to get back; not all coverage pays 100 percent for all procedures.
- Any unpaid amount of your deductible typically affects the amount you get reimbursed. Check the rules regarding your deductible so you know what to expect.
- Each insurance company has its own procedures you must follow when requesting to be reimbursed. Always use the form the company designates and include copies of all required documentation. Failure to follow all procedures can result in a delay or even a denial of your claim.
- Submit all of your papers to your insurance provider in a timely fashion, since the insurance company most likely has a deadline for filing claims. If you let the deadline slip by you won’t be able to get anything back. Send your claim in via certified mail so you have proof of when you sent it.
- Emed Ramps: Insurance Billing, Insurance Reimbursement
- Illinois Department of Human Services: The Insurance Reimbursement Process
- State of Oregon Insurance Division: Billing Process and Terms
- University of Washington Valley Medical Center: Billing and Insurance
- Cigna Insurance: Medical Claim Form and Instructions
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