How does the claims process work?
Three reasons to submit a claim, and what happens when you do.
As you use your 2019 health plan more, you may wonder how the claims process works — and why you might need to submit a claim.
When to submit a claim
In most cases, when you go to a network provider, you will not need to submit a claim for your care. However, there are a few occasions where submitting a claim on your own may be required, in order for you or the provider to receive reimbursement. Some examples include:*
- Dependent care: If you have an FSA account that covers reimbursement for childcare or elder care, a claim must be submitted for that reimbursement.
- Upfront billing: You may need to submit your own medical claim if you go to a provider who collects payment up front rather than billing the insurance company.
- Out-of-network: We know that as much as you try to see a network provider, sometimes it’s just not possible — like if you’re on the road or in an emergency situation. In that case, an out-of-network provider cannot submit a claim on your behalf, and you’ll have to submit this claim on your own.
We’ve made it easy to submit your claims, with two methods available.
Submit a claim online
Submitting your claims on myuhc.comOpens a new window® is a breeze. Log in and click the “Claims & Accounts” tab, then click the “Submit a Claim” tab. There, you’ll be able to select the corresponding “Online Submission Form” to begin the process for your claim.
Submit a claim by mail
Download the form for your claim at myuhc.comOpens a new window. This form may either be completed on your computer and printed out, or printed blank and then completed by hand using black or blue ink.
Once your claim form is complete, mail your form with the claim details and receipts to the address on the back of your health plan ID card.
Whether you submit a digital or hard copy form, here are some tips and tricks on how to make the claims process easy and efficient.
- Be sure to complete all of the applicable fields on the form. Ask your provider for the Provider Information or have them fill it out for you.
- Keep a copy of the form, claim details and receipts for your records.
- Send the claim as soon as possible, and as close to the date of service as possible.
- Complete a separate form for each claim.
- If you have other insurance or Medicare and it is primary to your UnitedHealthcare plan, include that corresponding Explanation of Benefits (EOB) with your claim.
What happens next
After your claim is processed, you’ll receive an EOB. This explains the charges applied to your deductible (the amount you pay for covered services before your plan begins to pay), plus any charges you may owe the provider. Keep your EOB on file in case you need it in the future. You may also review your EOB information on myuhc.comOpens a new window.
1 Asch, Steven M. et al. The New England Journal of Medicine. 2006 March 16; 354: 1147-1156.