insurance

What to Expect and How to File an Insurance Claim

If you have an international student insurance plan, you’ll need to file a claim with your insurance company, either to get reimbursed for expenses you paid up front or to make sure the provider gets paid. As with most private insurance plans, this is not done automatically, so there are a few steps you need to take to ensure your claims are processed without delay.

Step 1. Locate a provider within the network

Many times your insurance plan will have a list of doctors, hospitals and clinics that the insurance company contracts with directly. These providers have agreed to discount rates and accept direct payment by the insurance company (meaning you would not have to pay the full cost up front, just your deductible and/or copay). Before you get treatment, check out the provider lookup tool to see what’s in the network. In many plans within the US, out-of-pocket costs are often lower if you go in-network. Although coverage outside the US may be the same in-network or out-of-network, it’s a good idea to take advantage of direct pay.

Step 2. Submit your ID card to the provider

When you seek treatment at a doctor’s office, clinic or hospital, they won’t be able to tell if you have insurance unless you present your insurance identification card. If you don’t have one, be sure to call the provider after your visit and update their information with your ID card details. If you don’t, you will start getting bills and the insurance company will have no idea that you have a claim in process.

Step 3. Complete and submit your claim form

In most international insurance plans, you will ALWAYS have to fill out a claim form before your claim can be processed. A new claim form is normally required for each new illness you have. For example, if you have an illness where you see the doctor five times for the same illness, you would only have to submit the claim form once. Similarly, if you visit a doctor for two different conditions, you would need to submit two different claim forms.

Also, if the treatment was due to an accident, some insurance companies may ask you to also complete and submit an Accident Form. Once you complete the form, be sure to email the documents to the carrier for processing.

Step 4. Submit your invoices, receipts and any other supporting documentation

If you paid for anything in advance, or if you’re receiving bills from the doctor, clinic, or hospital, be sure to send them directly to the insurance company. This may include:

  • Receipt for payment of your deductible
  • Itemize bills or receipts (and they must be itemize. In the US this is often know as the UB or HCFA form)
  • Receipt of payment for your treatment

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

  • I-20
  • Visa
  • Passport

If you are in the United States, the insurance company will need the provider’s bills with the correct disease and treatment codes. This is often refer to as the UB or HCFA form. If the provider will be billing the insurance company directly, this is how they normally send it. However, if you paid for treatment up front, be sure to request it at the time of treatment so you can submit it to the insurance company.

Step 5. Wait 30 days and then follow up

By law, the insurance company can only keep a claim open for a short period of time before they have to process it. This means that if they don’t have all the information, they will have to deny the claim (but don’t worry, once you submit the correct information, they will reopen the claim and process it). To avoid delays, you can log in to your account to view the status, call the number on your ID card, or email the operator to get an update on your claim. Make sure you have the following information ready:

  • Insurance policy identification card/certificate number
  • Name on the policy
  • Date of Birth
  • Date of service (when you sought treatment)
  • Invoice amount, if available

Step 6. Receive an explanation of benefits with the processed claim

Once a claim has been process, an “Explanation of Benefits” (often referred to as an EOB) will be mail to you. The EOB will state what was process, what was and was not cover, and the patient responsibility (the amount you are responsible for paying the provider). If you need help understanding your EOB, check out this guide or call the number on your insurance card for assistance.

If you are being reimburse, it will often be by check, however you can choose to receive payment by electronic transfer. Check directly with your carrier if this would be your preferred method. These plans are in USD only, and typically a claim is process within 30 business days.

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