A Step By Step Guide to Making a Health Insurance Claim

In some cases a medical provider might require you to file your own health insurance claim form. For anyone who has never done this before the process can seem a little daunting. It’s important to understand the proper steps so that no mistakes are made and you don’t have to file again–or worse, be denied coverage. This is a step by step guide to making a health insurance claim which should make the process a little easier.


Some medical procedures, especially surgeries, require pre-approval from the health insurance provider before fees are covered. In order to get pre-approved for a procedure you have to submit a form requesting coverage and outlining the procedure. It’s extremely important to talk with your insurance provider before any procedure or medical treatment to ensure that it is included in your coverage. They will state whether or not a pre-approval form needs to be submitted. They might also be required to submit a statement attesting to this approval in writing.

Step One: Obtain Receipts

Any medical procedure will come with an itemized receipt for submission to the insurance company. This itemized receipt or form will cover any procedures or services that were performed by the hospital for the duration of the treatment in detail. This includes surgeries, medication, and hospital stay charges among other things. When the claim form is actually submitted you need to attach the itemized receipts to the billing form for the insurance company to review when considering your case.

Step Two: Obtain the Claim Form

The insurance company will provide the official claim form that needs to be filled out after a medical treatment. The questions on the form will not be difficult to answer; common questions include:

  • What was the purpose of the visit?
  • To whom should the insurance payments be made out?
  • What services were performed during the treatment?
  • What is the name of the hospital or doctor that performed the treatment?

The claim form should also ask for some other information about the doctor or hospital that pertains to the type of treatment you received.

Step Three: Copy Everything

This is one important step that is often overlooked by patients filing their own insurance claims. Insurance companies are frequently huge bureaucracies and have been known to lose files. When this happens it’s often very difficult to get replacements for the original itemized receipts without losing precious time, since there is a strict time limit for filing a claim. Making a copy of both the original completed form and any other documents can save a lot of headaches in the event that something gets lost.

Step Four: Review the Form and Send It

After the form is completely filled out and ready to go you will need to call the insurance company and run through your list of documents with one of their representatives. Ask about anything else that might be needed and make sure to ask how long it will take before the paperwork is reviewed and accepted. For the last step, send the form to the address provided (which should be printed on the form). To guarantee that there will be no “it got lost in the mail” excuses it is always wise to utilize certified or registered mail services, which give the sender a receipt and tracking information.

The process of making a health insurance claim is not difficult, but it can take some time if not followed correctly. Time is not something that is abundant in filing a medical claim, so it pays to be prepared. Always make sure you know what your insurance company expects so that you get your coverage with as little delay as possible.