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.
“For even the Son of Man came not to be served but to serve, and to give his life as a ransom for many.”
Scripture is offered for encouragement and reflection and is not a substitute for professional medical, legal, financial, or healthcare advice.
Your next steps
Pick your state to file a complaint against a health plan or request an external review.
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