How To Read A Health Insurance Claim?

Imagine this: you’ve been in a car accident and have to go to the hospital. You have health insurance, so you expect that the insurance will cover the majority of the hospital bill, if not all of it. But when you get the bill, you see that there are charges for things that you don’t even understand. What do all these codes and numbers mean? How much of this bill am I actually responsible for? If you’ve ever found yourself in this situation, don’t worry—you’re not alone. In this blog post, we will decode some of the most common terms and line items that you may see on your health insurance claim. By the end of this post, you will be a pro at reading your health insurance claim and understanding what it all means.

What is a Health Insurance Claim?

A health insurance claim is a request for payment that is submitted to an insurer by a healthcare provider on behalf of a policyholder. The claim includes information about the services rendered, the date of service, the diagnosis, and the charges.

How to Read a Health Insurance Claim

Assuming you have a basic understanding of insurance claims, let’s look at how to read a health insurance claim. At the top of the claim, you will find the patient’s name, address, and policy number. This is followed by the provider’s name, address, and tax identification number. Below this information, you will find a list of services rendered with dates and amounts charged for each.

On the right side of the claim, you will find the insurance company’s payment and adjustments. The payment is usually listed as a single figure and then itemized below it. The adjustments are listed as negative figures and may include such things as co-payments, deductibles, or coinsurance. The total of the payments and adjustments should equal the amount charged by the provider.

The Benefits of Reading Your Health Insurance Claim

When you receive your health insurance claim, it is important to review it carefully. This will help you to ensure that all of the charges are correct and that you are getting the coverage you need. By reading your claim, you can also catch errors and potential problems early on.

One of the biggest benefits of reading your health insurance claim is that you can make sure you are getting the coverage you need. Your policy should list all of the services and procedures that are covered, as well as the copayments or coinsurance amounts. If any of the charges on your claim do not match up with what is listed in your policy, contact your insurer right away.

Another benefit of reading your health insurance claim is that it can help you catch errors. Even if your insurer has processed your claim correctly, there may be mistakes on the bill from the hospital or doctor’s office. By catching these errors early, you can avoid paying for services that you did not receive or being billed for more than what was actually charged.

Overall, taking the time to read your health insurance claim can save you time and money. It is important to understand what services and procedures are covered by your policy so that you can get the care you need without any surprises. Additionally, reviewing your claims carefully can help you catch errors and avoid overpaying for medical services.


Now that you know how to read a health insurance claim, you can be sure that you are getting the coverage that you are entitled to. This will help you avoid any surprises when it comes time to pay your medical bills. If you have any questions about your coverage, be sure to contact your health insurance company for more information.