Claims 101
Understanding Insurance Claims
A claim is your insurance company's official record of a service you received. When it goes smoothly, it's invisible. When it doesn't, you get a bill, a denial, or an EOB you don't understand.
How a claim flows
Your provider submits the claim → insurer reviews it → issues an EOB (Explanation of Benefits) → any remainder becomes your bill.
Common reasons claims fail
Missing prior authorization, out-of-network provider, coding errors, or the insurer disputing medical necessity.
Your rights
You can request the claim details, appeal a denial (typically within 180 days), and escalate to an external reviewer.
“Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths.”