What is an Insurance Claim?
In order for the insurance company to make reimbursement to plan members for covered medical expenses, they must be notified of the expense. This is done through an insurance claim form. When using physicians that are contracted with the health insurance company, claims are usually submitted through the doctor’s office or the medical group. Even some non-participating providers will handle claims processing on behalf of the patient, but they may be less familiar with the guidelines of the various insurance companies than a physician that works with them on a regular basis. Most people that use their regular participating physicians will never need to get involved in the claims process, but should receive copies of any correspondence between the physician and the insurer. When the insurance company receives notice of a claim, the first thing they do is confirm that the medical services received by the insured member are covered under that member’s health plan. Each medical service is as
An insurance claim is the actual application for benefits provided by an insurance company. Policy holders must first file an insurance claim before any money can be disbursed to the hospital or repair shop or other contracted service. The insurance company may or may not approve the claim, based on their own assessment of the circumstances. Individuals who take out home, life, health, or automobile insurance policies must maintain regular payments called premiums to the insurers. Most of the time these premiums are used to settle another person’s insurance claim or to build up the available assets of the insurance company. But occasionally an accident will happen which causes real financial damage, such as a automobile wreck or a tornado or a work-related accident. At this point the injured policy holder has the right to file an insurance claim in order to receive money from the insurance company. In general, the insurance claim is filed with a local representative of the insurance co
