How to Write a Claim Letter for Health Insurance
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UPDATED: Mar 19, 2020
It’s all about you. We want to help you make the right coverage choices.
- It’s your right to appeal to your health insurance for covered services
- Keep copies of all receipts, tests, and results
- Make your health insurance claim letter short and to the point
Medical bills can get expensive even if you have health insurance. If you don’t have coverage or your policy is lacking in several areas, it’s important to understand your benefits. It’s even more important to realize even a doctor’s office visit or antibiotic prescription can be very expensive.
If your insurance company makes a mistake or a claim isn’t filed on your behalf, the costs can add up fast. But, you can help yourself by submitting a healthcare medical claim form. It’s easy to do, and you don’t have to be an expert in medical terminology or have a college degree to do it yourself.
A healthcare medical claim form provides patients with the means to file a claim on their own. If your individual doctor or healthcare provider didn’t submit the required documents for an insurance claim, you might be needed to provide a health insurance claim letter.
If your physician or healthcare provider didn’t file the appropriate paperwork and your claim was denied, it’s important to know you have the right to any health care benefits you pay for through employment. One way to fix this problem is to issue a claim letter to your health insurance company.
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Research to Complete before Writing a Health Insurance Claim Letter
Before you write a medical insurance claim letter, it’s important to do a bit of investigation first. For starters, you will need to acquire any required forms from your healthcare provider and insurance company. The forms will need to be filled out correctly and enclosed with the health insurance claim letter.
Next, you will want to check and make sure the services you are trying to get paid are available with your policy. If you are appealing to have tests and prescription medications covered, you will need to check those documents as well.
After you are sure the claim you are trying to get paid is covered by your insurance, it’s time to consider your deductible. Before writing or sending the letter, you’ll want to make sure your deductible is paid.
If the procedure you are asking for to be covered weren’t covered due to a deductible, a claim letter would not help. Insurance companies will not cover
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Who files medical claims?
You may think that it’s your doctor’s office responsibility to file your health insurance paperwork. But, that’s not true. Most offices and hospitals will file medical claims as a convenience to their patients. However, it is not their duty.
Patients will need to file their medical claims if help from a doctor’s office or hospital will not help. When you need to file a medical claim form, you will need to complete the following steps:
- Fill out the claim form
- Organize receipts, bills, and hospital discharge papers
- Any bills for prescription drugs
- Organize receipts chronologically
- Copies and results of tests
- Receipts for tests
- Letter from a doctor who prescribed the tests
- Surgeon’s bill (if applicable)
When should a health claim letter be filed?
A health insurance claim letter must be submitted as soon as possible after treatment. Ideally, the claim should be submitted within seven days of hospital discharge or when treatment is completed. The letter should be brief and direct. No one wants to or has time to read a long, drawn out letter.
Short and to the point is ideal. State the purpose of the letter in the very first sentence. Only details of the claim request and the policy number should be included. It’s important to realize this is not the place to complain about the doctor, nurses, or hospital for not filing the claim on your behalf.
The request letter should be addressed to the person who deals with the claim.
If you don’t know the name of the person the letter should be addressed to, you can call your insurance company to get the name of the third-party administrator.
Once you have this information, you should address the letter to the appropriate person.
Additionally, the letter should state the terms of the policy that the patient believes pertain to their case. For example, if a patient’s insurance coverage covers a medication, but the medication was not covered, the letter should request reimbursement for prescription medication.
Include Any Supporting Documentation
When preparing to submit a health insurance claim, it’s important to include any supporting documentation. Do not include original documentations. Instead, include copies.
Some insurance companies will request copies of receipts, reports, and notes. The insurance company has the right to request the originals as well.
For this reason, patients should always keep copies of all their paperwork. Examples of paperwork that should be maintained include bills, receipts, letters from a doctor, and any documentation that proves treatment was ordered by a qualified physician.
Only include documentation that is relevant to the treatment provided.
If you find that your health insurance hasn’t been billed for covered services, there is no need to panic. In most situations, writing a medical insurance claim letter can help you resolve the issue quickly.
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