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What is a Claim in Healthcare?

A formal request for payment submitted by either you or your healthcare provider to your health insurer after receiving items or services you believe should be covered by your insurance.

Key Points:

  • Claims are the means through which you seek reimbursement or coverage for medical expenses from your health insurance provider.
  • They document the services or items received, their costs, and the details necessary for the insurer to process the payment request.
  • Accurate and timely claim submissions are crucial for ensuring you receive the benefits you’re entitled to under your health insurance plan.

“Glossary.” HealthCare.gov, www.healthcare.gov/glossary/.

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