Filing a Health Insurance Claim

So you’ve decided on a health insurance plan that fits your needs, what now?

You will receive your ID card in the mail that has all of the information necessary that your health service provider will need to process your claim.

Individual claims must be submitted within 12 months of the service charge. Once the insurance company receives your claim it shouldn’t take more than 5 business days to process your claim and another 24hrs after processing to send out your re-imbursement. Make sure to include all necessary information including original receipts, for prompt processing and payment.

Many health care providers, hospitals, pharmacies dentists and optometrists most likely will bill your insurance provider right from the office, eliminating the process of having to fill out and send a claim form. If your health care provider does not bill your insurance provider directly, you are then required to pay the initial cost in full and then submit your claim yourself. You would then receive your re-imbursement by mail. You can use your receipts for tax purposes so make sure to retain the top portion of the cheque for verification.

Filing a Health Insurance Claim

Although a health insurance claim is simple enough to file, the procedure varies with each plan.

One type of plan may require that you pay your health care provider up front and then submit your receipt by mail or electronically for a reimbursement.

Another type of plan may provide you with a drug or dental ID card that allows the bill to be submitted directly to the insurer electronically for payment.

Most insurance claims must be filed no later than one year from the date of the medical procedure, health service or appointment.

It usually takes a week or two to process a claim if it’s straightforward enough, and if you have completed the claim form correctly and completely.  However, it will take longer if the insurer has to contact you to clarify any of the details on the claim. A more complicated claim, such as one involving a disability, typically requires a lengthier time period to process.

Your insurance company may deposit payment directly into your bank account, or they may send you a cheque accompanied by a statement with the details of your claim.