Filing Your Own Insurance Claims

I find that most of the time, since we see so many alternative and "off the beaten track" type practitioners, I have to file the insurance claims myself. This is a task I thorougly detest, so I've done everything I can to make it as easy and pleasant as possible, to help myself get it done. Here's my system:

You will need:

- A white binder, the kind with clear pockets on the front, back and spine for putting in your own covers
- 8 pocket tab dividers for the binder, the kind with pockets on both sides, and insertable tabs
- A trip to the copy store
- Stamps
- Business size envelopes
- Return address labels, if you have them
- 1 Letter-size manila folder
- Your computer and printer

Here's how I Set Up my Insurance Binder:

1. I put the tabs in the binder. I labeled them as follows:
TO FILE
PENDING CLAIMS
CLAIM FORMS
INSURANCE CARD COPIES
ENVELOPES
MASTERS

2. I printed out the claim form on our insurer's website. I copied the blank form a few times, and then filled it in for each member of my family that has a significant number of claims (but didn't sign them or fill in dates, or anything that changes with each one you file). I took these to the copy place along with my insurance card. I made 10-30 copies each of the filled-in claim forms, and 50 of the insurance card, because you have to include it with *everything*. The claim forms go in the "CLAIM FORMS" tab pocket and the insurance card copies in the "INSURANCE CARD COPIES" tab pocket.

3. I wrote the address for mailing the claims on a label inside the front of the binder - just so you can always find it!

4. I addressed and stamped a bunch of envelopes - to the insurance claim address, from me (return address labels) and first class stamps. So all you have to do is load the claim in them and stuff them in the mailbox. These go in the "ENVELOPES" tab pocket. I think it's better to address them by hand, so it doesn't look too "professional" to the insurance company, but I'm not sure it makes any difference.

5. I made a log form for recording each claim I filed. It has the following columns: Date of service, Description, Date filed, Charge Amount, Date received, Payment received and Explanation. The date and payment columns can be kind of small, and the Description and Explanation ones as wide as you have room for. I put this log form in the pocket inside the front cover of the binder. You can make this form with Excel or by hand, it doesn't matter. Put the master in the "MASTERS" pocket tab, and make a copy of it to use so you won't have to make it all over again.

6. Label the folder with the words "Completed Insurance Claims, 2005" (or the current year), and put it in side the back of the binder. You will put receipts in here after you receive the claims back. You will make a new folder for each year and file the old one with your other old files.

6. Using Word, I printed out a beautiful 8.5x11" cover page saying "Insurance" in big rainbow letters, and put it in the front cover. Anything to make it more appealing and easy to find! Use your creativity here.

So Here's What I do to file a claim:

1. I tend to collect a bunch of claims at a time and keep them in the "TO FILE" pocket, but you could just file each one as you get it - whatever way works for you.

2. Grab a blank claim form for the family member the claim is for, and fill in the specifics - date of service, prescription information, whatever, and sign and date it.

3. Make a copy of the receipt for the medical treatment or prescription. Staple this and a copy of your insurance card to the claim form.

4. Fold the stapled forms, put in a pre-addressed envelope and mail them.

5. Write the words "Claim filed" and the current date on the bottom of the original receipt and put it in the "PENDING CLAIMS" tab pocket.

6. Fill out the next line in the log on the inside of the binder front cover with the date of service, description, date claim filed and charge amount.

And when I get a Claim Back...

1. I fill in the rest of the line in the log, noting how much was received and any explanation of what was or wasn't covered and action to be taken.

2. If there is an obvious error, or if I expected it to be paid, I re-file it with a note to the insurance company about why I'm sending it in again, and make a new log entry. Otherwise, I take the original receipt out of the "PENDING CLAIMS" pocket, and put it in the "COMPLETED CLAIMS" folder inside the back of the binder.

NOTE: Anything that is a medical expense that I'm not going to file a claim for, either because it's not big enough to bother, or because I know it will be declined, I put a note on the receipt to that effect and put it directly in the "Claims Completed" folder in the back of the binder. That way, all our medical expense receipts end up in the same place at the end of the year.