What Is a Health Insurance Claim Form Used For?


Quick Answer

Medical offices and hospitals file health insurance claim forms with health insurance companies to request payment for medical services, according to About.com. Information required to complete health insurance claim forms typically includes the types of medical services performed, itemized and total cost of services or medications, and payee information.

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Full Answer

Medical offices considered "in-network" by a health insurance company typically file health insurance claim forms on behalf of the patient, states About.com. Patients receiving medical attention "out-of-network" typically have to contact health insurance companies to file health insurance claims. Additional information required to complete a medical claim form includes medical insurance codes, tax identification numbers, and a brief explanation of injuries or medical conditions.

Health insurance companies provide an Explanation of Benefits form that outlines all medical services provided and the amount paid for these services, explains About.com. This form also includes the copay, coinsurance or deductible amounts that the patient must pay out-of-pocket. Health insurance companies may deny health insurance claims for specific medications or procedures not covered under the insurance policy, reports HowStuffWorks.

If denied coverage, patients must contact health insurance companies to request a formal review of the claim, states HowStuffWorks. Patients can contact state health insurance departments for additional assistance, or to ensure the insurance company conducts a formal review within a reasonable amount of time.

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