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!
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ok on the EOB form it also has a 1,2,and 3 explanation of amounts not covered and it say's I will not be billed the difference, or they can not bill me the difference but I am, and when I call you the insurance company and ask if i have to pay it you say yes. And why am I having to pay for preventive screenings, paps smear, mammogram, ect.. i am 45 years old, my mother has had 2 breast removed because of breast cancer, yet I have had to pay for my mammogram. I was wondering why. Thank You Shani Goldsmith.
Hi Shani, If you'd like to send us a private message with your plan ID and contact information I can have my team give you a call to answer these questions. ~ Kayla
We visited the Drs offive today we went to walgreens to fill the rx but they told me one medicine was not covered. How do i claim this item? Or are not elegible?
Hi Salvador, If you'd like to send us a private message I can have my team take a look at what's going on. ~ Kayla
Hi , talking about claims there are reasons for claims to be denied. The insurance provider rejects a claim due to various reasons such as having a no covered charge, a referral or pre-authorization because of the usage of an out-of-network provider, minor transcription errors, the acceptance of claim in the wrong insurance company or other information errors. Know more about denial management at fasttrackclaimsinc.com/denialmanagement.html
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