How Does A Health Insurance Claim Work? 
How does a health insurance claim work ? Let 's follow a claim . First the billing is created in the doctor 's office where staff submits a claim for payment to an insurance company . This could be done anywhere from that day or later that month , depending on the office . I have known of providers who have sent collection notices before they 've even gotten around to billing . When the claim arrives at the insurance company it goes straight to the claims departement where the informaion is entered into the computers . Basically the claims person gets the bill , data entries the necessary information and hits enter . From that point on , most claims are untouched by human hands . The claim information goes into the computer where it is compared to the coverage the insured has . From that a payment and explaination of benefits page are created and sent on their ways . When I use the term untouched by human hands I mean not everything processed is checked to see if the parameters -LRB- plan design -RRB- are correct . Usually , only billings above a certain size are rechecked for accuracy . Years ago the threshold was 20,000 got a second look by a human for accuracy . Companies leave it up to the insured to find any small errors and call in for corrections . The cost of double checking every claim would be astronomical . 