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Will the physician's office file my health claims?

In most cases, your health provider will file your health claims with your insurance company for you after services are rendered. However, there are some circumstances that may require you to file your claims yourself.
  • If you have a fee-for-service indemnity plan, you may be required to file your own claim.
  • If you have a Preferred Provider Organization (PPO) plan or a plan that includes a Point of Service (POS) option, you may have to file your own claims if you seek help from an out-of-network provider or at an out-of-network facility, as when traveling.
  • If you have a short-term health insurance plan, you may need to file your own claims.
  • If you are covered by Medicare, doctors and suppliers are required by law to file claims for you within 12 months of providing those services or supplies. However, if they fail to do so, you may need to file a claim. If it is nearing the 12 month deadline and your provider has not filed the claim, call 1-800-MEDICARE (1-800-633-4227). Ask for the exact time limit for filing a Medicare claim for the service or supply you got. If it's close to the end of the time limit and your doctor or supplier still hasn't filed the claim, ask them to direct you to information on filing the claim yourself.
Be sure to read your plan documents carefully to understand not only the coverage for which you are eligible, but how claims for your health services will be processed. If you have claims related questions, call the customer service number on your insurance ID card.  And always hold on to paperwork associated with your medical care. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.