Health Insurance

Getting Your Claims Paid

Florida law standardizes the health insurance claim forms. Many hospitals, physicians and other providers will file your claims for you.

Health plans are required to pay, contest or deny your claim within 20 days of receipt of the claim if the provider filed the information electronically, or within 40 days if the claim was not submitted electronically. Claims that are contested must be either paid or denied within 90 days if filed electronically, or 120 days if not submitted electronically.

Although a service might be ordered by your physician, the service might not be covered by your insurance plan. Please review your coverage requirements and exclusions detailed in your insurance policy. You may be billed for these non-covered, or excluded services.

Listed below are some guidelines to follow if you are filing your own claim:

Guidelines
  • Inform your insurance plan about a claim in writing within 20 days of the accident or illness. Claims must be filed within 90 days
  • Fill out the claim form and attach copies of bills and, if required, have the hospital or provider fill out their section of the claim form
  • Keep copies of everything you send to your insurance plan