First off, let’s define claim. A “claim” is basically a receipt from a doctor's visit, a treatment, or a prescription drug purchase.
Usually, your provider or pharmacy will send this bill directly to your insurance company. You will rarely have to file a claim yourself. However, if you are billed in full and you believe your health insurance company should be helping you to pay your bill, you will need to “file a claim.”
To do this, you will need to complete a claim form and mail it to your insurance company. You can find the claim form on your insurance company’s website. You will need to include a copy of your itemized medical bill and any additional supporting documentation requested. An itemized bill is a list of all of the care you received broken down into billing codes. You can ask your medical provider for an itemized bill and they will understand what you need.
After your insurance company reviews and approves your claim, they will mail you a check. The amount you receive will be based on the specific terms of your plan. It typically takes up to 30 days to review a claim and then another 30 to receive your payment (this timeframe can vary by carrier). It helps to stay patient, but you can always call your insurance company to check up on your claim.
If you have questions about how to fill out the forms, please contact your insurance company directly by calling the number on the back of your insurance card and/or the claims form. You can also call the Member Experience team over Stride if you need any navigational assistance.