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Claims Processing: How to Write a Claim Letter

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A health insurance claim letter is a letter a claimant writes to a health insurance company if the claimant’s doctor has not properly filed a medical claim. This letter typically seeks for a reimbursement to the patient after the patient has already paid their medical bill, per the agreement between the claimant and the insurer. It is only effective if the services in question are covered under the claimant’s insurance, and is not intended to be used to seek reimbursement for items not usually covered.

Who is responsible for submitting the Claim Letter?

The claimant will be responsible for paying any deductions necessary, and these payments will not be reimbursed. As well, the claimant needs to be aware of all documents and forms that must be included in the claim, and they must correctly fill out and submit these papers. While these may be different from one case (or one insurer) to another, the basic forms should include the following:

  • The completed claim form
  • Any bills for services rendered such as prescriptions, treatments, or tests
  • Receipts for medical bills
  • Hospital discharge papers
  • Surgeon’s bill (if relevant)

If your insurer requires original copies of these documents, it’s wise to retain copies. Any additional documents supporting the claim may be helpful even if they are not strictly necessary.

The letter itself should be short and contain only the details of your request and your insurance policy number. The letter should cite the terms of the policy that apply to claim. Most insurers require that you submit these claims within 7 days of completion of treatment, so timely submission is important.

At Apex EDI, we’re interested in taking the mystery out of medical billing, and making it easier for everyone. Our medical clearinghouse services are to help simplify the medical claims process, and save medical, dental, vision, and chiropractic practices time and money that they can put towards taking better care of their patients. Want to see what our company can do for your practice? Request a demo today, and stop doing claims the old fashion way.



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