Medical Claims Process

The medical claims process involves a healthcare provider submitting a detailed report of services provided to your insurance company. The insurer reviews the claim to verify coverage and the necessity of care, then determines the amount they will pay based on your policy. You may need to pay any remaining costs, such as deductibles or co-pays. Once approved, the insurance reimburses the provider directly or pays you if you’ve already paid out of pocket. This process ensures that medical expenses are processed and settled efficiently between providers, patients, and insurers.