The last thing you want to worry about when you or a loved one is ill and needs medical attention is making an insurance claim. Health care can be confusing, jargon-filled, and can involve a significant amount of paperwork. Your insurance provider may deny your claim if you don't cross all of your Ts and dot all of your Is.
How would you know if you're filing a claim properly if you do learn that you must do so? Okay. Breathe in deeply. Let's go over the steps for submitting an insurance claim form.
How to submit a claim for insurance
Usually, you don't even notice the claim when you receive medical attention. For instance, if you have a sinus infection, phone your doctor, make an appointment, go in for a fast checkup, and possibly get an antibiotic prescription. Your co-payment is made, and you are then released to leave. The medical practice's billing department completes a CMS-1500 form, sometimes called a "pink sheet" due to its distinctive color. The last you know of it is when they send it to your insurance provider.
Well, that's how things typically go. You might need to submit an insurance claim form, depending on your health insurance plan and the services you receive.
Consider the following scenario: Your family and you travel to another state for a lengthy ski weekend. You hit that mogul one day while gliding down the slopes and you were going just a little bit too quickly. Your leg is broken when you fall. After a brief ambulance ride to the emergency room, you are given a cast, an X-ray, and a set of crutches.
Oh, and the small-town hospital is outside of your network and won't accept the insurance you have from three states away, so you also get a hefty bill. It will be necessary for you to submit a health insurance claim form. This is what you require:
1. Claim form
A health insurance claim form ought to be available on your insurance provider's website. This particular claim form will be unique to your health plan. They'll be able to submit the claim online, which is convenient. You should be ready to print the claim form, though, and mail it in as well. You might need to include the following information on the form:
Your group plan number, member number, or insurance policy number,
the name of the person undergoing medical care (you, your spouse, your child or anyone covered under your plan).
Whether you have coinsurance or dual coverage,
The diagnosis and treatment plan (like an injury, illness or preventive care)
If you have a work-related accident that is covered by workers' compensation, you might need to do a tonne of extra paperwork and work with an insurance provider other than your regular health insurance provider. You should speak with your human resources person or get legal advice from a workers' compensation expert.
This also holds true whether you sustain injuries as a result of someone else's carelessness or in a car accident (like if you slip and fall on a wet surface inside of a business). It helps to have someone on your side because these cases can become very complex.
2. A detailed invoice and receipts
This is crucial. An itemised invoice from your provider is a necessary. It should describe each service your doctor rendered in detail and including details like:
such as blood testing or urine tests
imaging tests such as X-rays, MRIs, and CT scans
medication given out
cardiovascular examinations such as echocardiograms and EKGs
durable medical supplies such as braces or crutches