In many situations your health care team will submit insurance claims on your behalf. However, if your plan requires that you pay for medical services up front and submit a claim for reimbursement, you will probably be required to submit your claim yourself. If you are filing a claim for a medical procedure/service or prescription drugs, keep in mind that many health plans require that you complete a claim form.

Follow These Steps When Submitting a Claim:

  • Determine the type of claim form your insurance plan requires. If necessary, contact your insurance company’s member services department for guidance.
  • Obtain the correct claim form from the member services department of your insurance company or your employer.
    • Follow the instructions on the claim form. Be sure to include:
      • Patient’s full name, address and phone number
      • Patient’s Social Security number
      • Patient’s date of birth and gender
      • Policy and group number
      • Policy holder’s name, if different from patient
      • Policy holder’s relationship to patient
  • Attach a copy of any requested supporting information to the claim form. Check the claim form for completeness and accuracy. Be sure to sign the claim form.
  • Make a copy of the claim form and all attachments (i.e., receipts, medical records, etc.) for your records.
  • Mail the claim form and all attachments to the claims department of your insurance company.

If you are required to submit a claim form for pharmacy benefits, your pharmacist can provide you with the National Drug Code (NDC) that you should include on the claim form.

Check Your Claim Status

Your claim can take four to six weeks to process. If payment has not been received within six weeks of submission, you should call your insurance company to check on the status of your claim. The customer service department is the best place to start.

Before you call, be sure to have the following information:

  • Date of service
  • Type of service received or name of the drug for which the claim was submitted
  • Name of provider who performed the service or dispensed the medication
  • Total charge submitted for reimbursement
  • Policy number (found on your insurance card)
  • Name of insured
  • Insured’s date of birth