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What is a health insurance claim? A claim is simply a bill that your doctor or other health care provider will send to a health insurance company (such as Blue Cross and Blue Shield of Texas) for payment after they have treated you.
In most cases, your doctor or other health care provider’s office will submit the claim for you so you don’t have to worry about it. But there are some instances when you may have to file the claim yourself, such as when you get care from an out-of-network provider. Which brings us to the next question: What is a health insurance claim form?How to Submit a ClaimIf you do have to file a claim, here’s what you need to do:
It’s a good idea to make copies for your records. The bill you send in with your claim will not be sent back to you.
Also be sure to file your claim soon after you receive care. This is more important when you have a claim from late in the year, to make sure your claim is applied to the right plan year. Check the Status of a ClaimThere are a couple ways you can check the status of your claim:
Please note that the claim will not show up in Blue Access for Members until it is processed. There are 2 types of claims statuses that you will see within Blue Access for Members: “Paid” or “Processed”. “Paid” means we have paid for the services. “Processed” means it is in the works, but no money has been sent out to pay the claim yet. You can also sign up for text/email alerts to notify you when the status of your claim changes. All you have to do is:
Explanation of Benefits (EOB) StatementOnce your claim has been processed by us, you will receive an EOB, either by mail or email. This document will break down:
If your claim has been denied, you can file an appeal to have it looked at again. The appeals information is located with your EOB. Still have questions? Ask us in the comments!
What is “special processing”
How would you advise if a hospital billing department fails to file the claim in a timely manner, please? We are told the billing Dept was waiting for the first insurance provider to finalize their portion first before billing the other insurance provider.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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