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.
“Wait for the Lord; be strong, and let your heart take courage; wait for the Lord!”
Scripture is offered for encouragement and reflection and is not a substitute for professional medical, legal, financial, or healthcare advice.