Health Insurance Claims Explained

For most policyholders, health insurance claims are not part of the process that involves their attention. Typically, health insurance claims are not something that the insured person has to deal with, because the doctor’s office charges the insurance company directly. In addition, most policyholders verify any costs to them before they come to an office visit. Moreover, any necessary information is already provided to the office staff to bill the insurance company for the patient’s health care services.

What are Claims?

Understanding how to process health insurance claims begins with understanding what claims are. Health insurance claims are simply the bill that is received for health care services rendered. In most cases, when insured people visit the doctor they pay their portion, typically called a co-pay or another required co-insurance amount. The co-pay is often a predetermined fee that remains the same. However, if there is no co-pay, the plan will usually have a co-insurance, or a specified percentage that is owed. The difference that is not paid by the patient is billed to the insurance company, and that is the claim.

Verify Costs Before Visits

It is plausible to find out what the costs are going to be before attending a doctor’s office visit. Many insured people like to be prepared for their portion of the bill before they make an appointment to receive health care services. In fact, it is most beneficial to contact your insurance representative who can supply information about the costs that you, as the policyholder will be required to pay. As a result, contacting the insurance representative ahead of time prevents any unnecessary worrying about the cost of the visit and prevents any surprises due to unexpected expenses.

Extensive Paperwork

When visiting the doctor’s office, most people see the extensive paperwork that is required upon arrival. This paperwork is what is needed to properly process health insurance claims. Information forms that you fill out provide the doctor with your family health history so that he or she can properly care for your specific needs. Additionally, this paperwork provides all of the necessary information for the office to prepare the claims and send them to the appropriate insurance provider.

What Happens after Co-pay

Typically, when you visit the doctor and pay the co-pay or the co-insurance payment, the rest of the bill that is due is sent to the insurance company. The insurance company acquires all of the necessary information and paperwork from the doctor’s office. The paperwork is then evaluated to see if the services are covered under the policy. If the services rendered are covered within the insurance policy, then payment is submitted to the doctor’s office. In most cases, the patient is not even aware of the health insurance claims portion of the billing process.

Health insurance claims are most frequently handled by the doctor’s office, hospital, or clinic. Vary rarely does the insured policyholder become involved with claims other than to fill out the extensive paperwork that is required by the doctor’s office. In most situations, the insured person pays their co-payment at the office visit, or their co-insurance charge and the rest of the bill is sent to the insurance company directly. Find low cost health insurance by using the free online form at the top of the page. Its easy to fill out and will save you that money and find that health insurance company you need.

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