Instructions For Filing a Health Insurance Claim

by Francine Richards ; Updated July 27, 2017
Health insurance companies will deny a claim if the claim form is incomplete.

Items you will need

  • Claims form
  • Itemized provider or hospital bill

Providers and hospitals usually take ownership of submitting health insurance claims on behalf of their patients. They want payment for treating patients and have dedicated staff handling claims filing. Most provider claims filing is electronic, but occasionally you may pay a doctor or hospital bill directly and seek reimbursement from your health insurance company. When this happens, like the provider, you will need to file a paper claim. This may occur if you receive out-of-network services or your provider requires up-front payment.

Step 1

Visit the website of your health insurance carrier to determine which claims forms they accept. Download the claim form if available. If they only accept CMS 1500 or UB-04 forms, ask your provider to send you a blank form. Only bulk forms are available for download or purchase.

Step 2

Complete a separate claim form for each family member. Fill out the patient’s insurance information, identification number, name, address, city, state, zip, date of birth, phone number, relationship to policyholder and secondary coverage details.

Step 3

Fill out the remainder of the claims form including name of the provider, description of services received, charges, diagnosis, dates of service and provider tax ID number. You may also need to answer a few questions about whether your condition is work or accident related.

Step 4

Sign the claim form. The health insurance company may not accept the form without a signature. Attach the itemized provider’s bill. Review the bill to make sure it is on the provider’s letterhead and contains the patient’s name, dates of service, description and charges of each service.

Step 5

Mail the claim form, itemized bill and additional information as requested to the address on the claims form. If using a CMS 1500 or UB-04, obtain the claims submission address from your insurance company’s website or call the number on the back of your ID card and ask a representative for the address.

About the Author

Francine Richards is a licensed multi-state insurance agent with years of human resources and insurance industry experience. Her work has appeared on Blue Cross Blue Shield websites and newsletters, the Houston Chronicle and The Nest. Richards holds a Bachelor of Arts in communications from the University of Maryland.

Photo Credits

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