Streamlining the process for receiving medical reimbursements

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Nicole Anzia, Special To The Washington Post
·5 min read

Health-care reimbursements. Those words are the source of so much frustration, dread and procrastination. Many people would choose paying bills, doing their taxes or creating an estate plan over dealing with reimbursements from their health-care companies.

I get it. Health insurance coverage is confusing. You may only be reimbursed a fraction of your out-of-pocket costs, and dealing with reimbursements is monotonous work. But if you can get organized and create a system, it really isn't that difficult to keep up with your claims. Plus, a relatively small investment of time can lead to more money in your pocket.

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- The basics

With most health-care plans, if you're seeing an in-network doctor, then your only required expense is your co-pay. But if you go to an out-of-network provider or to a specialist whose services aren't covered under your plan, you often have to pay, then file a claim with your insurance company if you want to recover a portion of that cost.

The doctor's office will sometimes submit the bill to the insurance company for you, but more frequently, the office gives you the bill and proof of payment, and it's up to you to request a reimbursement. There's no requirement that you file a claim, but not submitting a bill that may be partially covered can prevent you from recovering any of the cost.

Step 1: Organize paperwork

This can be the most difficult part for many people. You leave your doctor's office with an itemized receipt, then you shove it in your pocket or purse, or you put it in your car's console, and then you forget about it. Or maybe your spouse goes to an out-of-network provider and puts the bill on a desk and it doesn't resurface for six months.

The best way to keep track of medical bills is to designate a specific, convenient spot for them. Create a file or envelope called "Claims to Submit," and put it in an accessible spot, such as in a cabinet drawer in your entryway or a wall pocket in your mudroom or home office. Instruct family members to put all receipts there immediately.

Step 2: Submit your claim

Unless you've had a significant procedure with enormous out-of-pocket costs, you're probably not going to submit each bill immediately. The frequency with which you submit depends on how many bills you have each month, but it's better to err on the side of filing more frequently rather than waiting too long, which increases the risk of losing the paperwork, forgetting to submit or missing the deadline. Plan to file either once a month or once a quarter. Insurance companies will accept claims for differing amounts of time past the date of service, but it's a good idea to file within a year.

Most claims can be submitted by mail or online. Online claims require less time and are processed more quickly than those submitted by mail. You fill out the appropriate online form, scan and attach the required documents, and choose whether the payment should be sent to the provider or to you. You'll need the date, provider, diagnosis, cost of treatment and, in some cases, the provider's tax ID number. Although it takes some time and effort to create your online account, filing electronically simplifies tracking your claims and expedites reimbursements. Additionally, you'll be able to confirm that your claim was received, easily flag claims to view later and more quickly submit additional or corrected information. And, of course, filing electronically doesn't require stamps, envelopes or a trip to the post office. If you don't have a printer or scanner at home, there are several apps that use your smartphone's camera to make copies of documents or receipts and save them.

If you submit claims manually, locate the appropriate form on your health insurer's website, and print out multiple copies to have on hand for later. If you're confused about which form to submit, call and ask.

Fill out the general and personal information on the form clearly using a black or blue pen. Make 20 copies, and place them in a file called "Health-Care Reimbursement Forms" for future use. Then gather the bills you're seeking reimbursement for, and fill out the remainder of the form for those expenses. (Note: You can submit bills from different doctors for one person on one form, but you can't submit bills for you and your children on the same form.) Don't forget to sign and date the form, and make copies of the form you're submitting, as well as the actual bills. You need to send in the original bills, but keep copies for your records. Then double-check the website or call to confirm that you're using the proper address. Health insurance companies often have several addresses associated with them or different addresses for different types of claims.

Step 3: Finish up

If you're submitting by mail, a response will take a few weeks. Once you receive an explanation of benefits and (hopefully) a check, clip them together with your original submission form, billing documents and receipt, then file them in a folder called "Completed Health-Care Submissions." Many people suggest keeping paperwork related to medical bills for at least three years.

There are a lot of reasons people visit out-of-network doctors, including proximity or a preference for seeing a highly recommended specialist. Many times, it's because a lot of mental health providers don't file with insurance companies. Whatever the reason, it's worth setting up a schedule and system for submitting your claims. After you've submitted a couple of times, the process should be pretty efficient. Filling out a few forms to recoup potentially hundreds or thousands of dollars is definitely time well spent.

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