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A claim is simply a bill your doctor and other health care providers 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 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: How do you file a health insurance claim?
If you have to file a claim, here’s what you need to do:
There 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 three types of claims statuses that you will see:
Once 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!
Originally published 2/10/2015; Revised 2022
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.
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.
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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