How are Health Insurance Claims Processed?


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Every insurance company has its own claim procedures. When filing a claim with your health insurance, you need to follow the steps as outlined by your insurance company. In most cases, claims are denied by a mere technicality.

The best place to find information on claiming your medical insurance is your health insurance company itself. Generally, you are provided a toll free contact number that you can call during business hours. When speaking with your health insurance company's representative on the phone, you may be required to provide some details like your policy number and name of the primary insured of the policy. After this, the representative can access the details of your policy and guide you on the steps you need to take to your claim.

If you happen to be a Managed Care Plan participant and have a covered benefit, the process is pretty straightforward. You just have to visit your insurance company and the staff there will take care of the rest. They will take care of everything - from entering the appropriate code for the service rendered to sending the paperwork back to you. You will receive a document detailing your visit to the office. The document will also give the details on how much the company paid, how much was applicable as deductible and the balance that you are supposed to pay, if any. At the time you avail the medical care, you only need to pay the co-payment amount.

Before, an Indemnity Plan holder is required to pay the entire amount for the medical service rendered to them upfront. Then the policyholder has to complete lengthy claim documents, which usually took weeks to clear. But nowadays, the front office personnel directly bill the insurance company first and after the company pays up the percentage, the balance will be taken from you, the patient. If there is a disagreement over the payment, you will have to pay it up. You can then sort it out with your insurance company later on.

Computerization has made the medical billing process very easy. You no longer have any extra costs to bear apart from paying your co-payment amount. If you have not satisfied your deductible, the paperwork is still forwarded so as to help keep track of the use of policy and the payments due. The task involved in processing a claim is complex, but health insurance claims for covered benefits are nowadays settled in a short period of time.

Timothy Gorman is a successful Webmaster and publisher of Easy Health Insurance Guide . A website that specializes in providing health insurance advice to include easy ways to find cheaper health insurance by providing tips on lowering your health insurance costs that you can research in your pajamas from the comfort of your own home on his website at


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