How To File An Insurance Claim and What To Expect

Filing an Insurance Claim

If you have an international student insurance plan, then you will need to file an insurance claim with your carrier to either get reimbursed for expenses you paid upfront, or to make sure the provider gets paid. Like most private insurance plans, this is not done automatically, so there are a few steps you’ll want to make sure you follow to ensure that you have your claims processed without delay.

Step 1. Locate An In-Network Provider

Often times your insurance plan will have a list of doctors, hospital and clinics that are contracted directly with the insurance company. These providers have agreed to discounted rates and to accept payment directly from the insurance company (meaning that you would not have to pay the full cost upfront, but only your deductible and/or copay). Before going for treatment, check the provider search tool to see who is in-network. For many plans, your out-of-pocket costs in the US are often lower if you go inside the network. While coverage may be the same in-network or out-of-network outside the US, you can still take advantage of direct payment.

Tip: Many times the insurance plan will use a network that is already in existence. Because of this, it’s important that when calling a doctor’s office, you let them know the name of the network (i.e., First Health, United Healthcare, etc.) – not the name of the insurance plan. If you aren’t sure of your network, take a look at your ID card as the logo will appear right on the card.

Step 2. Present Your ID Card to the Provider

When seeking treatment at a doctor’s office, clinic or hospital, they will not know that you have insurance unless you present your insurance ID card. If you don’t have it, be sure to call the provider after your visit and update their information with the details on your ID card. If you don’t do this, you will start receiving bills and the insurance company will have no idea that you have an ongoing claim.

Tip: When seeking treatment, we recommend that you ask for the receipts, invoices, medical records and any other documents they may have while at the provider’s office. The insurance company can ask for this while processing the claim, so getting them in advance will allow you to have them on hand if requested.

Step 3. Fill Out and Send In Your Claim Form

For most international insurance plans, you will need to file an insurance claim by ALWAYS filling out a claim form. A new claim form is typically required for every new condition you have when filing an insurance claim. For example, if you have a condition where you see the doctor five times for the same condition, you would just need to submit the claim form once. Likewise, if you visited a doctor for two separate conditions, you would need to submit two different claim forms.

Additionally, if treatment was due to an accident, some insurance companies may require you to complete and submit an Accident Form as well. Once you complete the form, be sure to email the documents to the carrier to process.

Important: Claims can only be submitted within a certain period of time, which will depend on your plan. Don’t wait to file a claim, fill out that claims form and submit the documentation as soon as you are able to.

Step 4. Submit Your Bills, Receipts, and Any Other Supporting Documentation

If you paid for anything up front, or if you are receiving bills from the doctor, clinic or hospital, be sure to submit them directly to the insurance company. To file an insurance claim, you will want to include:

  • Receipt for the payment of your deductible
  • Itemized bills or receipts (and they must be itemized! This is often referred to in the US as the HCFA or UB form)
  • Receipt for the payment of your treatment

For those of you who are students, you may also need to submit proof of student status including:

  • I-20
  • Visa
  • Passport

If you are in the United States, the insurance company will need the bills from the provider with the appropriate codes for the condition and treatment. This is often referred to as the HCFA or UB form. If the provider will be billing the insurance company directly, this is the form they typically submit. However, if you paid for the treatment upfront, be sure to ask for this at the time of treatment so that you can submit this to the insurance company.

Prescriptions – Prescriptions are often paid out of pocket at the pharmacy, and submitted for reimbursement. Depending on your plan, you have a prescription discount card that you can present to get a reduced rate. To submit a claim for a prescription, you will need to submit the office visit, prescription, the receipt for the prescription as well as the claims form to be reimbursed.

Step 5. Wait 30 Days, Then Follow Up

By law, the insurance company can only keep a claim open for a small window of time before they have to process it. This means that if they don’t have all the information, they are going to have to deny the claim (but don’t worry, once you submit the appropriate information, they’ll reopen the claim and process it). To avoid any delays, you can either log into your account to view the status, call the number on your ID card, or email the carrier for an update on your claim. Be sure to have the following information ready:

  • Insurance policy ID/certificate number
  • Name on the policy
  • Date of birth
  • Date of service (when you sought treatment)
  • Amount of the bill, if available

Step 6. Receive Explanation of Benefits With Processed Claim

Once a claim has been processed, an Explanation of Benefits (often referred to as an EOB) will be mailed to you by post. In the EOB it will state what was processed, what was and wasn’t covered, and the patient responsibility (the amount you are responsible for paying directly to the provider). If you need help understanding your EOB, check out this helpful guide or call the number on your insurance card for assistance.

If you are being reimbursed, then this will often be by check, however you can opt to receive a wire transfer payment instead. Check with your carrier directly if that would be your preferred method. These plans are in USD only, and a claim is typically processed within 30 business days.

For more information on how to file an insurance claim, please check with the carrier directly to see what and where to submit your documentation.

Posted by Jennifer Frankel

Jennifer is the International Director at International Student Insurance. Jennifer is a graduate of the University of Florida where she holds a Masters in International Business and a Bachelors of Science in Business Administration. She has lived and worked abroad in Mexico, Chile, Costa Rica and England, and traveled extensively in South America, Europe and Asia.

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