Most of us never have to deal with the burden of having to file a health insurance claim. Not for routine visits at least. There are some unique circumstances/arrangements that may facilitate the need to manually submit your very own claims to your health insurance company for reimbursement.
To fully understand the "why" and the "how" of health insurance claims, or filing health insurance claims, we must first try to peel a few layers off the "what" of health claims.
Most of us never have to worry about filing claims for routine services simply because, we typically visit a health provider or health providers who "are in the network". What this means (in part)is that the provider, AKA doctor has a way to submit claims (electronically) on your behalf.
However, there are times when you, the patient, will have to submit a claim yourself. This could be because you are seeing a doctor who is not in your health plan's network or who does not accept insurance.
What is a health insurance company, really.
The simplest way to put this is that a health insurance company is an entity that collects a steady stream of payments from its customers with the understanding that should any of its customers need medical services, the health insurance company will cover some or all of the costs of said medical services. The health insurance company will often pay your providers directly.
What is a health insurance claim?
A health insurance claim is when you request reimbursement or direct payment for medical services that you have already obtained.
When you visit your doctor...
Who does not take insurance or is not in your plan's network, she will ask that you pay her directly for services. You can then file a claim to (potentially) be reimbursed by your health insurer
Here is what you do:
Obtain Itemized Receipts
You will need to ask your doctor for an itemized bill. An itemized bill lists every service that your doctor provided and gives the cost of each of the services. Make sure any medications or drugs provided during any treatment are listed with itemized costs. Your health insurance company will need you to attach the original itemized bills to the claim form.
Get a claim form
You then need to visit your health insurance provider's website to obtain a claim form. The claim form will also have further instructions.
Once you have your claim form filled out and your itemized bills from your doctor, don't forget to make copies of everything. It will eliminate any errors that may be made in the claim process and make it easier for you to re-file your health insurance claim if it gets lost. You may also want to check the billing codes for medical errors and contact your health provider if you need clarification. This step will avoid having your health insurance denied for incorrect information.
Review then Send
To make sure everything is completely accurate, call your health insurance company and tell them you are about to send in your health insurance claim form. Review with them all the paperwork you have and ask them if there is anything else you need.
Also, ask your insurance company how long should you expect to wait for your claim to be paid and mark that date on your calendar. Once you have everything in order, send out the claim form to your insurance company.
The address to send the claim form should be on the claim form itself. Keep an eye out on your calendar for the claim date that you marked and contact your insurance company if you don't receive your claim within the time frame given to you.
If you need a claim form or help on how to file a claim, call Blue Cross NC's Customer Service at 1-877-258-3334 or write to:
Blue Cross NC Customer Service
P. O. Box 2291
Durham, NC 27702-2291
Got questions about filing a claim with Bright health? Call: 866-239-7191 or write to
Bright Health Plan
PO Box 16275
Reading, PA 19612-6275
Payer ID CB186