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Filling Out A Medical Insurance Claim Like A Pro

Posted on 07/19/19 by Malloy Law Offices in Injuries,Uncategorized

Did you suffer a personal injury and now are facing lots of bills and needing to file a medical insurance claim? While this can be extremely frustrating and confusing, we are here to provide you quick and easy steps to make the process as easy a possible. Filling out a medical insurance claim is not rocket science, but it can be frustrating if you have never done it before. Fortunately, most medical providers will fill out the form on your behalf and submit it to your insurance company electronically. If they are not caught up with the times or the healthcare provider is outside of your insurance’s network, you will have to fill out and submit the form yourself. Here is a step by step guide to make the task a bit less painful.

Where Do I Start?

Before you can fill out and submit a medical insurance claim form, you have to first gather some information. This includes:

  • Itemized bill from your healthcare provider(s):
    You need the line items costs for things such as the office visit, medications, medical procedures, and lab work. This should include the date of the visit, medical procedure codes and the diagnosis codes.
  • Healthcare provider’s information:
    You need their tax identification number and their NPI (National Provider Identifier) number.
  • Insurance policy information:
    You need to know your policy number, group number, and member ID. These are typically listed on your insurance card or can be found by logging on to your insurance provider’s website. They should also be printed on the paper statement mailed to your home, if you opted to receive one.

Time to Fill Out the Medical Insurance Claim Form

You gathered all the required information, now it’s time to dive in and fill out the form. Most insurance providers use a similar claim form, but it is important that you fill out your provider’s specific version. It should be on their website where you can download, print, and then mail it, or better yet, submit it electronically. The forms usually include the following sections:

  • Policy Section:
    This is where you will enter data such as the policy number, group number, and member ID.
  • Patient Section:
    This section is specific to the individual that received care. It may be the person that holds the policy, a spouse, or child. They need to have been covered by your insurance plan before the time the medical visit occurred. This section typically includes the patient’s first and last name, address, phone number, date of birth, and gender.
  • Policy Holder Section:
    This section is specific to the individual that holds the insurance policy. They are most often an employee of the company that has offered medical coverage as a benefit. This section typically includes the policy holder’s first and last name, address, phone number, date of birth, and gender. They may ask for the policy holder’s member ID here as well.
  • Provider Section:
    This section captures the information concerning the healthcare organization that provided the medical service to the individual listed in the patient section. This usually includes their organization’s name, address, phone number, tax identification number, and NPI number. This is also where you will most often provide the medical procedure and diagnosis codes, along with the cost for each. This information should be on the bill you gathered before starting the claim process.
  • Accident Information Section (If applicable):
    If your visit to a medical provider was due to an accident, you will need to include some basic information. This may include the date of the accident, where it occurred, and then an explanation concerning how it occurred.
  • Other Insurance Provider Section:
    If the patient is covered by any other insurance provider other than the one for which they are filling out the claim, that company’s information should be entered in this section. It will include the provider’s name, address, and policy number.
  • Sign and Date:
    Don’t forget to sign and date the form before you submit it to your insurance provider. They usually will not process the claim, if you neglect to do so.

Make Copies and Submit

Once you have filled out the claim form, take a moment and print a copy for your records. Also, make a copy of the healthcare provider’s bill(s) you will send along with the claim. After you make the copies, submit the claim form and a copy of the medical bill(s) via your insurance provider’s website, or print and mail them to their claims processing address.

Malloy Law Offices, LLC

If you suffered an injury and need help taking the next steps, call our personal injury attorneys today. We are here to make your experience as easy and compensating as possible. Call us today at (888)- 291- 6445.