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FAQ48: How can one tell if an insurance claim has been paid?
by Sydney Gartenburg


Several people have written to me about not knowing how much their insurance company may have paid for a claim or even if it was paid at all.

Anytime a claim is submitted to your insurance company you should receive a statement of benefits from them. The statement of benefits will either show that the bill was paid or was denied. If it was paid it will indicate how much, when it was paid, to whom it was paid and (usually but not always) what amount you may still owe as your share of the bill. If the claim was denied, the statement of benefits should indicate a reason for the denial. The most usual reason is because the claim was not coded properly by the billing office. You can discuss this with the manager there and ask them to resubmit with the correct procedure or diagnosis code.

Now, this is the most important part. If you have not received a statement of benefits from the insurance company it is a good sign that they did not get a claim at all. Perhaps your provider has been slow at billing or the bill was sent to the wrong insurance company or something like that. You can call the billing office and ask what is going on. This would make more sense than waiting and doing nothing until you get a dunning letter from a collection agency as once happened to me.

I hope that this has been of some help.



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