HOW TO FILE AN INSURANCE CLAIM

If your plan requires that you pay for medical services up front and submit a claim for reimbursement, you will probably be required to submit your claim yourself.

Contact your insurance company to obtain information on how to file the claim correctly or to request the proper claim form. If filing a claim for a medical procedure/service or prescription drugs, many health plans require that you complete a claim form.

Follow these steps when submitting a claim:

  • Determine the type of claim form your insurance plan requires. If necessary, contact your insurance company's member services department for guidance.

  • Obtain the correct claim form from the customer service department of your insurance company or your employer.

    • Follow the instructions on the claim form. Be sure to include:
      • Patient's full name, address and phone number
      • Patient's Social Security number
      • Patient's date of birth and gender
      • Policy and group number
      • Policy holder's name, if different from patient
      • Policy holder's relationship to patient

    • Attach a copy of any requested supporting information to the claim form.

    • Check claim form for completeness and accuracy.

    • Be sure to sign the claim form.

  • Make a copy of the claim form and all attachments (i.e., receipts, medical records, etc.) for your records.

  • Mail the claim form and all attachments to the claims department of your insurance company.

If you are required to submit a claim form for pharmacy benefits, your pharmacist can provide you with the National Drug Code that you should include on the claim form.


Contact us with insurance questions, success stories, suggestions, or requests to volunteer.


PHA is proud to be able to make educational materials and programs like these available for free to everyone because of the generous support from members of the community just like you. Donations are welcome!

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The information provided on the PHA website is provided for general information only. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

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